Healthcare Provider Details

I. General information

NPI: 1912193764
Provider Name (Legal Business Name): CHRISTINE FERNANDEZ RN,PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 CLAREMONT AVE FL 2
OAKLAND CA
94618-1033
US

IV. Provider business mailing address

6200 MCBRYDE AVE
RICHMOND CA
94805-1200
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax:
Mailing address:
  • Phone: 510-231-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number545453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: