Healthcare Provider Details

I. General information

NPI: 1154830966
Provider Name (Legal Business Name): DAVID A FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date: 07/07/2020
Reactivation Date: 06/24/2026

III. Provider practice location address

4455 E 12TH AVE
DENVER CO
80220
US

IV. Provider business mailing address

4455 E 12TH AVE
DENVER CO
80220-2415
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0023036
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: