Healthcare Provider Details

I. General information

NPI: 1689892101
Provider Name (Legal Business Name): CEFERINO AME FERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7909 RAINIER AVE S
SEATTLE WA
98118-4444
US

IV. Provider business mailing address

7909 RAINIER AVE S
SEATTLE WA
98118-4444
US

V. Phone/Fax

Practice location:
  • Phone: 206-722-5254
  • Fax: 206-723-4060
Mailing address:
  • Phone: 206-722-5254
  • Fax: 206-723-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD 00022075
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: