Healthcare Provider Details

I. General information

NPI: 1629249438
Provider Name (Legal Business Name): ROBIN IRENE FERNANDES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN IRENE DAVID NP

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 64TH ST STE 100
EMERYVILLE CA
94608-2038
US

IV. Provider business mailing address

2001 DWIGHT WAY
BERKELEY CA
94704-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-629-6682
  • Fax: 510-830-3316
Mailing address:
  • Phone: 510-204-1591
  • Fax: 510-204-7822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: