Healthcare Provider Details

I. General information

NPI: 1780240697
Provider Name (Legal Business Name): KARLA FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 SAWTELLE BLVD STE 31
LOS ANGELES CA
90025-3272
US

IV. Provider business mailing address

2558 S SEPULVEDA BLVD APT 2
LOS ANGELES CA
90064-3171
US

V. Phone/Fax

Practice location:
  • Phone: 949-447-0816
  • Fax:
Mailing address:
  • Phone: 661-431-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: