MEDICARE: GENESIS 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
1	235Z00000X	Speech-Language Pathologist	38468	CA

General Provider Information

NPI Number	:	1568063030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENESIS FERNANDEZ

Provider Business Mailing Address
First Line	:	16700 NORWALK BLVD
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-1838
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19600 JACOB AVE
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-7526
Country	:	US
Telephone Number	:	562-229-7895
Fax Number	:

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

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	05/13/2026

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Directions to “ GENESIS FERNANDEZ ” Practice Location

Language	Start Address	Practice Location

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