MEDICARE: VANESSA FERNANDEZ

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1316685019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANESSA FERNANDEZ

Provider Business Mailing Address
First Line	:	605 W SAN YSIDRO BLVD APT 188
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-2364
Country	:	US
Telephone Number	:	619-272-9021
Fax Number	:	619-329-9663

Provider Business Practice Location Address
First Line	:	PASEO DE LOS HEROES 10289
Second Line	:	INTERIOR 8002
City	:	TIJUANA
State	:	BAJA CALIFORNIA
Zip	:	22010
Country	:	MX
Telephone Number	:	619-272-9021
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. VANESSA FERNANDEZ
Credential	:	DDS
Telephone Number	:	619-272-9021

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	05/23/2022

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Directions to “VANESSA FERNANDEZ ” Practice Location

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