Healthcare Provider Details

I. General information

NPI: 1124328406
Provider Name (Legal Business Name): MR. RONNIE FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 PARAMOUNT BLVD STE 200
DOWNEY CA
90241-3351
US

IV. Provider business mailing address

5150 E PACIFIC COAST HWY SUITE 100
LONG BEACH CA
90804-3312
US

V. Phone/Fax

Practice location:
  • Phone: 562-231-6974
  • Fax:
Mailing address:
  • Phone: 562-490-7600
  • Fax: 562-490-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number85914
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW85914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: