Healthcare Provider Details

I. General information

NPI: 1285712190
Provider Name (Legal Business Name): TONY C. FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S EAST AVE
FRESNO CA
93706-5104
US

IV. Provider business mailing address

2555 S EAST AVE
FRESNO CA
93706-5104
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-2400
  • Fax: 559-264-9241
Mailing address:
  • Phone: 559-499-2400
  • Fax: 559-264-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA78382
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA78382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: