MEDICARE: DR. JORGE ANTONIO FERNANDEZ JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	A83383	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295778090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE ANTONIO FERNANDEZ JR. M.D.

Provider Business Mailing Address
First Line	:	393 E. WALNUT STREET
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91188-0001
Country	:	US
Telephone Number	:	626-405-7966
Fax Number	:	626-405-4600

Provider Business Practice Location Address
First Line	:	393 E. WALNUT STREET
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91188-0001
Country	:	US
Telephone Number	:	626-405-7966
Fax Number	:	626-405-4600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	11/15/2011

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