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General NPI Number Information
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NPI Number | 1033888417
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Entity Type | Individual
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Provider Name | PEDRO MANUEL DUARTE FERNANDES JR.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 970 GRIFFITH DR
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City | DIXON
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State | CA
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Zip | 95620-4817
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Country | US
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Telephone | 510-619-6444
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Fax |
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Provider Business Mailing Address
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Address Line | 6400 TUPELO DR
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95621-1741
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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