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General NPI Number Information
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NPI Number | 1720750193
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Entity Type | Individual
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Provider Name | MARIA FERNANDA FERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 5107 S INTERSTATE 35
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City | AUSTIN
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State | TX
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Zip | 78744-2736
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Country | US
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Telephone | 830-513-7240
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 LADY BIRD LN APT 329
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City | AUSTIN
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State | TX
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Zip | 78741-0027
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Country | US
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Telephone | 830-513-7240
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 118591
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License Number State | TX
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