Healthcare Provider Details

I. General information

NPI: 1285691121
Provider Name (Legal Business Name): DIONISIO A. FERNANDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13847 E 14TH ST. STE 112
SAN LEANDRO CA
94578
US

IV. Provider business mailing address

3448 MOWRY AVE
FREMONT CA
94538-1422
US

V. Phone/Fax

Practice location:
  • Phone: 510-352-8585
  • Fax: 510-352-8644
Mailing address:
  • Phone: 510-373-3000
  • Fax: 510-744-9959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA29416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: