Healthcare Provider Details

I. General information

NPI: 1073426805
Provider Name (Legal Business Name): NANCY FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 HOLLY DR
TRACY CA
95376-2170
US

IV. Provider business mailing address

3231 LAKESHORE CT
STOCKTON CA
95219-5491
US

V. Phone/Fax

Practice location:
  • Phone: 209-830-3350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: