Healthcare Provider Details

I. General information

NPI: 1548502545
Provider Name (Legal Business Name): ANGELINE FERNANDES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 DUBLIN BLVD STE 315G
DUBLIN CA
94568-2929
US

IV. Provider business mailing address

444 N 14TH ST
SAN JOSE CA
95112-1723
US

V. Phone/Fax

Practice location:
  • Phone: 925-828-8240
  • Fax:
Mailing address:
  • Phone: 650-284-6570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 9941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: