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NPI Code Detail

MEDICARE: NICOLETTE FERNANDEZ

MEDICARE: NICOLETTE 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
1224Z00000XOccupational Therapy AssistantOTA3614CA

General Provider Information

NPI Number : 1336788041
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLETTE FERNANDEZ
Provider Business Mailing Address
First Line : 7605 EL CAPITAN WAY
Second Line :
City : BUENA PARK
State : CA
Zip : 90620-1818
Country : US
Telephone Number : 714-321-0647
Fax Number :
Provider Business Practice Location Address
First Line : 3401 CEDAR AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-4422
Country : US
Telephone Number : 562-426-4461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2019
Last Update Date : 12/27/2019

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Directions to “ NICOLETTE FERNANDEZ ” Practice Location

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