Healthcare Provider Details

I. General information

NPI: 1669650909
Provider Name (Legal Business Name): INGRID FERNANDEZ-PANNITTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W 20TH AVE
SAN MATEO CA
94403-1341
US

IV. Provider business mailing address

150 W 20TH AVE
SAN MATEO CA
94403-1341
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-2931
  • Fax: 650-341-0674
Mailing address:
  • Phone: 650-573-2931
  • Fax: 650-341-0674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: