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General NPI Number Information
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NPI Number | 1760758106
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Entity Type | Individual
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Provider Name | DAMIAN OLIVIER FERNANDEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1010 MURRAY AVE
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1806
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Country | US
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Telephone | 516-572-5881
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Fax |
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Provider Business Mailing Address
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Address Line | 251 VISTA DEL MAR AVE
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City | PISMO BEACH
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State | CA
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Zip | 93449-1830
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Country | US
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Telephone | 858-999-6368
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | CA-A141808-A
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A141808
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License Number State | CA
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