=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003297698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA FERNANDEZ MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2015
-----------------------------------------------------
Last Update Date | 10/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4530 S DECATUR BLVD STE 201B
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89103-5239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-486-7581
-----------------------------------------------------
Fax | 702-486-7576
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 E WARM SPRINGS RD STE 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-4345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-486-7581
-----------------------------------------------------
Fax | 702-486-7576
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 12101-C
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------