Healthcare Provider Details

I. General information

NPI: 1912197518
Provider Name (Legal Business Name): SAVITHRI HAPUHENNADIGE FERNANDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 S WELLS ST
EDNA TX
77957-4045
US

IV. Provider business mailing address

1013 S WELLS ST
EDNA TX
77957-4045
US

V. Phone/Fax

Practice location:
  • Phone: 361-782-3560
  • Fax: 361-782-3560
Mailing address:
  • Phone: 361-782-3560
  • Fax: 361-782-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM7969
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberM7969
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM7969
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: