Healthcare Provider Details

I. General information

NPI: 1881858439
Provider Name (Legal Business Name): MARIFEL M FERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 COMO AVENUE MS 31100A - HEALTHPARTNERS COMO CLINIC
ST PAUL MN
55108-1460
US

IV. Provider business mailing address

8170 33RD AVE S MS21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 650-641-6200
  • Fax: 651-641-6205
Mailing address:
  • Phone: 651-641-6200
  • Fax: 651-641-6205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51422
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number54413
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: