Healthcare Provider Details

I. General information

NPI: 1609780493
Provider Name (Legal Business Name): CYRIL J FERNANDEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10221 156TH ST E
PUYALLUP WA
98374-5690
US

IV. Provider business mailing address

10908 57TH AVENUE CT E APT C201
PUYALLUP WA
98373-5718
US

V. Phone/Fax

Practice location:
  • Phone: 253-292-5297
  • Fax:
Mailing address:
  • Phone: 760-987-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: