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General NPI Number Information
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NPI Number | 1124165261
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Entity Type | Individual
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Provider Name | DR. VIVIAN FERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 9340 W STOCKTON BLVD
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City | ELK GROVE
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State | CA
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Zip | 95758-8014
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Country | US
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Telephone | 916-683-5732
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Fax |
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Provider Business Mailing Address
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Address Line | 9320 ELK GROVE BLVD STE 170
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City | ELK GROVE
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State | CA
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Zip | 95624-5061
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Country | US
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Telephone | 916-714-5422
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Fax | 916-714-5429
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 54142
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License Number State | CA
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