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General NPI Number Information
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NPI Number | 1346376563
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Entity Type | Individual
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Provider Name | ALEXIS NICOLE FERNANDEZ M.A
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Gender | Female
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 900 BROADWAY STE 910
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City | NEW YORK
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State | NY
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Zip | 10003-1249
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Country | US
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Telephone | 310-970-4744
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 PACIFIC HWY UNIT 2806
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City | SAN DIEGO
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State | CA
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Zip | 92101-8466
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Country | US
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Telephone | 310-970-4744
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 001-084
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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