=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881069979
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSA FERNANDEZ OEZDEMIR RDHAP, RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2015
-----------------------------------------------------
Last Update Date | 12/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14349 SARATOGA AVE APT C
-----------------------------------------------------
City | SARATOGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95070-5949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-566-2233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14349 SARATOGA AVE APT C
-----------------------------------------------------
City | SARATOGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95070-5949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-566-2233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 559
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------