Healthcare Provider Details

I. General information

NPI: 1316325020
Provider Name (Legal Business Name): LUZ YEE FERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 GENESEE AVE
SAN DIEGO CA
92123-4219
US

IV. Provider business mailing address

5651 COPLEY DR STE A
SAN DIEGO CA
92111-7903
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2600
  • Fax:
Mailing address:
  • Phone: 858-262-6070
  • Fax: 858-262-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA152997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: