Healthcare Provider Details

I. General information

NPI: 1225624927
Provider Name (Legal Business Name): THERESE DUENAS-FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BROADWAY STE 500
OAKLAND CA
94607-4033
US

IV. Provider business mailing address

1236 DARTMOUTH AVE
SAN LEANDRO CA
94579-1126
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-2464
  • Fax: 510-267-3212
Mailing address:
  • Phone: 510-828-3767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN45629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: