Healthcare Provider Details

I. General information

NPI: 1750593349
Provider Name (Legal Business Name): ELIZA MARIE FERNANDO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12444 WASHINGTON BLVD
WHITTIER CA
90602-1005
US

IV. Provider business mailing address

13444 DARVALLE ST
CERRITOS CA
90703-6323
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0161
  • Fax: 562-698-8740
Mailing address:
  • Phone: 562-229-0905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA61717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: