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General NPI Number Information
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NPI Number | 1982904231
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Entity Type | Individual
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Provider Name | MATILDA FRANCES FERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 2504 CAMINO ENTRADA
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City | SANTA FE
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State | NM
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Zip | 87507-4851
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Country | US
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Telephone | 505-216-2727
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28220
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City | SANTA FE
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State | NM
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Zip | 87592-8220
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Country | US
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Telephone | 505-471-5006
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Fax | 505-820-9220
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | SWB-2024-0655
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License Number State | NM
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