Healthcare Provider Details

I. General information

NPI: 1316417769
Provider Name (Legal Business Name): DANYELLE FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 WOODRUFF AVE STE 305
LONG BEACH CA
90808-2146
US

IV. Provider business mailing address

5555 GARDEN GROVE BLVD STE 200
WESTMINSTER CA
92683-8234
US

V. Phone/Fax

Practice location:
  • Phone: 562-982-0050
  • Fax:
Mailing address:
  • Phone: 714-804-5725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number8894
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: