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NPI Code Detail

MEDICARE: JOSE DAVID FERNANDEZ

MEDICARE: JOSE DAVID 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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1790617603
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE DAVID FERNANDEZ
Provider Business Mailing Address
First Line : 701 W KIMBERLY AVE STE 220
Second Line :
City : PLACENTIA
State : CA
Zip : 92870-6314
Country : US
Telephone Number : 714-879-4247
Fax Number :
Provider Business Practice Location Address
First Line : 701 W KIMBERLY AVE STE 220
Second Line :
City : PLACENTIA
State : CA
Zip : 92870-6314
Country : US
Telephone Number : 714-879-4247
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2026
Last Update Date : 06/03/2026

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Directions to “ JOSE DAVID FERNANDEZ ” Practice Location

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