NPI Code Detail JSON Logo

1154830966 NPI number — DAVID A FERNANDEZ

NPI Number: 1154830966
Health Care Provider/Practitioner: DAVID A FERNANDEZ

Information about “1154830966” NPI (DAVID A FERNANDEZ) exists in 1154830966 in HTML format HTML  |  1154830966 in plain Text format TXT  |  1154830966 in PDF (Portable Document Format) PDF  |  1154830966 in an XML format XML  formats.

NPI Number : 1154830966 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154830966",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FERNANDEZ",
    "FirstName": "DAVID",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4455 E 12TH AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DENVER",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80220-2415",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4455 E 12TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DENVER",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80220",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "303-504-6500",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/25/2017",
    "LastUpdateDate": "06/24/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "07/07/2020",
    "NPIReactivationDate": "06/24/2026",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101Y00000X",
        "TaxonomyName": "Counselor",
        "LicenseNumber": "0023036",
        "LicenseNumberStateCode": "CO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.