MEDICARE: JESSICA 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	101YS0200X	School Counselor	250083075	CA

General Provider Information

NPI Number	:	1659231199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA FERNANDEZ

Provider Business Mailing Address
First Line	:	5424 E ARBOR RD APT G26
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 RIPLEY AVE
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-4555
Country	:	US
Telephone Number	:	310-798-8636
Fax Number	:

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

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	11/17/2025

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