Healthcare Provider Details

I. General information

NPI: 1851782361
Provider Name (Legal Business Name): KAREN ROSARIO FERNANDEZ M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 ALLSTATE DR
RIVERSIDE CA
92501-1702
US

IV. Provider business mailing address

6700 INDIANA AVE
RIVERSIDE CA
92506-4290
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-1227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number84176
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF84176
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number123224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: