Healthcare Provider Details

I. General information

NPI: 1922287929
Provider Name (Legal Business Name): GERMAN ERNESTO FERNANDEZ P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 BEVERLY BLVD STE 212
LOS ANGELES CA
90004-4429
US

IV. Provider business mailing address

4214 BEVERLY BLVD STE 212
LOS ANGELES CA
90004-4429
US

V. Phone/Fax

Practice location:
  • Phone: 213-385-9912
  • Fax: 213-385-9915
Mailing address:
  • Phone: 213-385-9912
  • Fax: 213-385-9915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: