Healthcare Provider Details

I. General information

NPI: 1609963156
Provider Name (Legal Business Name): RJ FERNANDEZ MD INC APC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 4TH AVE STE 201
CHULA VISTA CA
91910-4428
US

IV. Provider business mailing address

450 4TH AVE STE 201
CHULA VISTA CA
91910-4428
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 Number207R00000X
License Number StateCA

VIII. Authorized Official

Name: MR. RODRIGO JOSE FERNANDEZ. M.D.
Title or Position: OWNER / MD
Credential: M.D.
Phone: 619-476-9054