Provider Demographics
NPI:1093441875
Name:FERNANDEZ, ANTHONY RAYMOND JR (PMHNP, MSN, RN)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RAYMOND
Last Name:FERNANDEZ
Suffix:JR
Gender:M
Credentials:PMHNP, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26946 FAYENCE DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4506
Mailing Address - Country:US
Mailing Address - Phone:951-809-1099
Mailing Address - Fax:
Practice Address - Street 1:3030 W OLYMPIC BLVD STE 217
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-6507
Practice Address - Country:US
Practice Address - Phone:213-550-2159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health