Healthcare Provider Details

I. General information

NPI: 1194171454
Provider Name (Legal Business Name): ADULT MEDICINE AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 4TH AVE SUITE 516
CHULA VISTA CA
91910-4414
US

IV. Provider business mailing address

480 4TH AVE SUITE 516
CHULA VISTA CA
91910-4414
US

V. Phone/Fax

Practice location:
  • Phone: 619-476-9054
  • Fax: 619-476-9056
Mailing address:
  • Phone: 619-476-9054
  • Fax: 619-476-9056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. RODRIGO JOSE FERNANDEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-476-9054