Healthcare Provider Details

I. General information

NPI: 1194664060
Provider Name (Legal Business Name): RAY FERNANDEZ NBC-HWC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13354 SUTTER MILL RD
POWAY CA
92064-4902
US

IV. Provider business mailing address

13354 SUTTER MILL RD
POWAY CA
92064-4902
US

V. Phone/Fax

Practice location:
  • Phone: 951-816-7629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3783553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: