MEDICARE: JOHN FERNANDEZ JR.

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1528518172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN FERNANDEZ JR.

Provider Business Mailing Address
First Line	:	4777 BENNETT DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6907
Country	:	US
Telephone Number	:	702-291-7121
Fax Number	:

Provider Business Practice Location Address
First Line	:	4777 BENNETT DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6907
Country	:	US
Telephone Number	:	702-291-7121
Fax Number	:

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

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	01/22/2018

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