MEDICARE: ARALY ABIGAIL 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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1912228057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARALY ABIGAIL FERNANDEZ

Provider Business Mailing Address
First Line	:	974 JELLEY DR APT E
Second Line	:
City	:	PORT HUENEME
State	:	CA
Zip	:	93041-4404
Country	:	US
Telephone Number	:	805-901-8581
Fax Number	:

Provider Business Practice Location Address
First Line	:	974 JELLEY DR APT E
Second Line	:
City	:	PORT HUENEME
State	:	CA
Zip	:	93041-4404
Country	:	US
Telephone Number	:	805-901-8581
Fax Number	:

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

Provider Enumeration Date	:	06/11/2010
Last Update Date	:	06/11/2010

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