Healthcare Provider Details

I. General information

NPI: 1467541375
Provider Name (Legal Business Name): GILBERT RIENZIE FERNANDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18350 ROSCOE BLVD #714
NORTHRIDGE CA
91325-4109
US

IV. Provider business mailing address

18350 ROSCOE BLVD #714
NORTHRIDGE CA
91325-4109
US

V. Phone/Fax

Practice location:
  • Phone: 818-727-7073
  • Fax:
Mailing address:
  • Phone: 818-727-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberC40808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: