Healthcare Provider Details

I. General information

NPI: 1902427404
Provider Name (Legal Business Name): CHRISTOPHER RAUL FERNANDEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N ASHWOOD AVE
VENTURA CA
93003-1810
US

IV. Provider business mailing address

3401 W GORE BLVD
LAWTON OK
73505-6332
US

V. Phone/Fax

Practice location:
  • Phone: 805-658-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number20A22770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: