MEDICARE: MRS. LETICIA 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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1902092398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LETICIA FERNANDEZ

Provider Business Mailing Address
First Line	:	555 E OCEAN BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5003
Country	:	US
Telephone Number	:	562-424-1869
Fax Number	:	562-683-2686

Provider Business Practice Location Address
First Line	:	555 E OCEAN BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5003
Country	:	US
Telephone Number	:	562-424-1869
Fax Number	:	562-683-2686

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

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	07/14/2023

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