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General NPI Number Information
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NPI Number | 1336948348
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Entity Type | Individual
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Provider Name | JHOAN FERNANDEZ
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Gender | Male
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 401 PARADISE RD
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City | MODESTO
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State | CA
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Zip | 95351-3163
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Country | US
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Telephone | 209-722-4842
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Fax |
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Provider Business Mailing Address
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Address Line | 1316 K ST
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City | MODESTO
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State | CA
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Zip | 95354-0918
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Country | US
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Telephone | 209-522-1010
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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