Healthcare Provider Details

I. General information

NPI: 1518666981
Provider Name (Legal Business Name): CARLA VERONICA FERNANDEZ RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 REYNOLDS RD
RIVERSIDE CA
92503-3517
US

IV. Provider business mailing address

528 W VALLEY BLVD APT 528
COLTON CA
92324-2249
US

V. Phone/Fax

Practice location:
  • Phone: 833-391-0505
  • Fax:
Mailing address:
  • Phone: 951-236-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95166005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: