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General NPI Number Information
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NPI Number | 1679229876
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Entity Type | Individual
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Provider Name | MICHAEL BRANDON FERNANDEZ PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 2600 PACIFIC COAST HWY STE 150
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City | CORONA DEL MAR
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State | CA
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Zip | 92625-2144
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Country | US
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Telephone | 949-640-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 21827 ARBOR CT
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City | WALNUT
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State | CA
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Zip | 91789-1490
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Country | US
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Telephone | 909-868-8427
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 301638
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License Number State | CA
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