Healthcare Provider Details

I. General information

NPI: 1407953300
Provider Name (Legal Business Name): ROGELIO FERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 S NEWMARK
PARLIER CA
93648-2639
US

IV. Provider business mailing address

155 S NEWMARK
PARLIER CA
93648-2639
US

V. Phone/Fax

Practice location:
  • Phone: 559-646-1200
  • Fax: 559-646-6622
Mailing address:
  • Phone: 559-646-1200
  • Fax: 559-646-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG67336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: