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General NPI Number Information
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NPI Number | 1417989062
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Entity Type | Individual
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Provider Name | DIANE MARIE FERNANDEZ M.S.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 150 MUIR RD
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City | MARTINEZ
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State | CA
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Zip | 94553-4668
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Country | US
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Telephone | 925-372-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 154 CHESTNUT DR
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City | HERCULES
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State | CA
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Zip | 94547-1310
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Country | US
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Telephone | 510-799-5283
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AU-1206
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License Number State | CA
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