MEDICARE: APRIL DESIREE FERNANDO PH.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	103TC0700X	Clinical Psychologist	PSY17072	CA

General Provider Information

NPI Number	:	1497809982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL DESIREE FERNANDO PH.D

Provider Business Mailing Address
First Line	:	1643 N ROCKWELL ST # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5217
Country	:	US
Telephone Number	:	510-875-5552
Fax Number	:

Provider Business Practice Location Address
First Line	:	1643 N ROCKWELL ST # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5217
Country	:	US
Telephone Number	:	510-875-5552
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	06/06/2016

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