Healthcare Provider Details

I. General information

NPI: 1316445018
Provider Name (Legal Business Name): BERTRAND & FERNANDEZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12808 W AIRPORT BLVD STE 275L
SUGAR LAND TX
77478-6245
US

IV. Provider business mailing address

12808 W AIRPORT BLVD STE 275L
SUGAR LAND TX
77478-6245
US

V. Phone/Fax

Practice location:
  • Phone: 281-755-3870
  • Fax:
Mailing address:
  • Phone: 281-755-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: JASON FERNANDEZ
Title or Position: DIRECTOR
Credential:
Phone: 281-755-3870