Provider Demographics
NPI:1033161336
Name:FERNANDEZ, FERNANDO BARR (DDS)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:BARR
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 E OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5120
Mailing Address - Country:US
Mailing Address - Phone:323-722-6360
Mailing Address - Fax:
Practice Address - Street 1:5740 E OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-5120
Practice Address - Country:US
Practice Address - Phone:323-722-6360
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4951701OtherDELTA DENTAL HEALTHY FAMI
0007225604OtherAETNA
01621125OtherUNITED CONCORDIA
CA11894501OtherDENTAL BENEFITS PROVIDERS
CA7022774OtherUNITHED HEALTHCARE
CAG9314501OtherDENTI-CAL
130881OtherGUARDIAN
CA44021OtherPACIFICARE