Healthcare Provider Details

I. General information

NPI: 1609270685
Provider Name (Legal Business Name): FLORENCE FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

26404 VERMONT AVENUE UNIT 15
HARBOR CITY CA
90710-3404
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-1694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number693868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: