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General NPI Number Information
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NPI Number | 1104200575
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Entity Type | Individual
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Provider Name | VINAY THOMAS FERNANDES M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 875 BLAKE WILBUR DRIVE CC-2226A
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City | STANFORD
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State | CA
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Zip | 94305
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Country | US
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Telephone | 650-736-1680
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Fax |
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Provider Business Mailing Address
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Address Line | 875 BLAKE WILBUR DRIVE CC-2226A
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City | STANFORD
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State | CA
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Zip | 94305
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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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | A137644
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | A137644
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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