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NPI Code Detail

MEDICARE: LYNN FERNANDEZ

MEDICARE: LYNN 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1447389218
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN FERNANDEZ
Provider Business Mailing Address
First Line : 6415 GARVANZA AVE APT 104
Second Line :
City : HIGHLAND PARK
State : CA
Zip : 90042-2768
Country : US
Telephone Number : 323-356-6979
Fax Number :
Provider Business Practice Location Address
First Line : 3455 PERCY ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90023-1716
Country : US
Telephone Number : 323-268-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/08/2007

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Directions to “ LYNN FERNANDEZ ” Practice Location

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