Healthcare Provider Details

I. General information

NPI: 1659387272
Provider Name (Legal Business Name): STEPHANIE MARIE NEVAREZ-FERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE MARIE NEVAREZ-FERNANDEZ MD

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTH VALLEY HEALTH CENTER 2001 CENTRO FAMILIAR BLVD SW
ALBUQUERQUE NM
87105-4592
US

IV. Provider business mailing address

PO BOX 912678
DENVER CO
80291-2678
US

V. Phone/Fax

Practice location:
  • Phone: 505-873-7400
  • Fax: 505-877-4400
Mailing address:
  • Phone: 505-241-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20060304
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: