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General NPI Number Information
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NPI Number | 1437427648
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Entity Type | Individual
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Provider Name | WILLIAM CASEY FERNANDEZ LSA
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Gender | Male
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 03/08/2019
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Provider Practice Location Address
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Address Line | 1825 SAN JACINTO ST UNIT 844
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City | HOUSTON
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State | TX
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Zip | 77002
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Country | US
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Telephone | 832-671-9795
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20054
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City | HOUSTON
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State | TX
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Zip | 77225-0054
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Country | US
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Telephone | 832-671-9795
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Fax | 888-573-3784
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | SA00510
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License Number State | TX
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