Healthcare Provider Details

I. General information

NPI: 1528095866
Provider Name (Legal Business Name): ZOLISSA FERNANDO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17909 SOLEDAD CANYON RD # 100
SANTA CLARITA CA
91387-3210
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 661-367-3500
  • Fax: 661-367-3539
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: