MEDICARE: GERMAN ERNESTO FERNANDEZ P.A.

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	363A00000X	Physician Assistant	PA18790	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA18790	OTHER	CA	STATE OF CALIFORNIA

General Provider Information

NPI Number	:	1922287929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERMAN ERNESTO FERNANDEZ P.A.

Provider Business Mailing Address
First Line	:	4214 BEVERLY BLVD STE 212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4429
Country	:	US
Telephone Number	:	213-385-9912
Fax Number	:	213-385-9915

Provider Business Practice Location Address
First Line	:	4214 BEVERLY BLVD STE 212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4429
Country	:	US
Telephone Number	:	213-385-9912
Fax Number	:	213-385-9915

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

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/26/2007

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Directions to “ GERMAN ERNESTO FERNANDEZ P.A.” Practice Location

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