Healthcare Provider Details

I. General information

NPI: 1225528755
Provider Name (Legal Business Name): JOSUE FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 PLUMMER ST BLDG 200-2134
NORTH HILLS CA
91343-2036
US

IV. Provider business mailing address

16111 PLUMMER ST BLDG 200-2134
NORTH HILLS CA
91343-2036
US

V. Phone/Fax

Practice location:
  • Phone: 818-891-7711
  • Fax: 818-895-9452
Mailing address:
  • Phone: 818-891-7711
  • Fax: 818-895-9452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number286921
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA185563
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number275646
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: