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General NPI Number Information
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NPI Number | 1295965796
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Entity Type | Individual
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Provider Name | JOSEPH R FERNANDEZ JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 07/17/2009
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Provider Practice Location Address
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Address Line | 755 WEST RANCHO BLVD
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City | PALMDALE
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State | CA
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Zip | 93551
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Country | US
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Telephone | 661-265-7800
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Fax | 661-265-7084
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Provider Business Mailing Address
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Address Line | 2860 MICHELLE 2ND FLOOR
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City | IRVINE
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State | CA
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Zip | 92606-1009
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Country | US
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Telephone | 714-368-2077
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Fax | 714-368-2092
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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 | 25706
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License Number State | CA
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