Healthcare Provider Details

I. General information

NPI: 1518202035
Provider Name (Legal Business Name): LEONOR FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 VISTA WAY STE 258
OCEANSIDE CA
92056-4565
US

IV. Provider business mailing address

3605 VISTA WAY STE 258
OCEANSIDE CA
92056-4565
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1480
  • Fax:
Mailing address:
  • Phone: 760-758-1480
  • Fax: 760-435-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW118709
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW84406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: