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General NPI Number Information
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NPI Number | 1316972250
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Entity Type | Individual
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Provider Name | ROSALIE FERNANDEZ SIA M.D
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1510 FLORIDA AVE
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City | MODESTO
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State | CA
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Zip | 95350-4437
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Country | US
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Telephone | 209-574-1030
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Fax | 209-574-1038
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Provider Business Mailing Address
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Address Line | 1910 CUSTOMER CARE WAY
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City | ATWATER
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State | CA
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Zip | 95301-5167
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Country | US
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Telephone | 209-384-6488
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Fax | 855-202-9336
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 001069
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 001069
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | C129786
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License Number State | CA
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