MEDICARE: HECTOR J. FERNANDEZ, M.D. INC

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	174400000X	Specialist	G320200	CA

General Provider Information

NPI Number	:	1518277516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HECTOR J. FERNANDEZ, M.D. INC

Provider Business Mailing Address
First Line	:	1970 OLD TUSTIN AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-7865
Country	:	US
Telephone Number	:	714-542-0102
Fax Number	:	714-479-0709

Provider Business Practice Location Address
First Line	:	1970 OLD TUSTIN AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-7865
Country	:	US
Telephone Number	:	714-542-0102
Fax Number	:	714-479-0709

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HECTOR JIMENEZ FERNANDEZ
Credential	:	M.D.
Telephone Number	:	714-542-0102

Provider Enumeration Date	:	10/09/2010
Last Update Date	:	10/09/2010

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