Healthcare Provider Details

I. General information

NPI: 1740145283
Provider Name (Legal Business Name): DENISE ALEJANDRA FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S RAMONA ST
SAN GABRIEL CA
91776-2398
US

IV. Provider business mailing address

801 S RAMONA ST
SAN GABRIEL CA
91776-2398
US

V. Phone/Fax

Practice location:
  • Phone: 626-943-6830
  • Fax:
Mailing address:
  • Phone: 626-943-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number230106018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: