Provider Demographics
NPI:1194845230
Name:FERNANDEZ, GUADALUPE REYES (NP)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:REYES
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HOBSON WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6706
Mailing Address - Country:US
Mailing Address - Phone:805-385-4455
Mailing Address - Fax:805-385-4408
Practice Address - Street 1:650 HOBSON WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6706
Practice Address - Country:US
Practice Address - Phone:805-385-4455
Practice Address - Fax:805-385-4408
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN369951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine