Provider Demographics
NPI:1225624927
Name:DUENAS-FERNANDEZ, THERESE
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:DUENAS-FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-1126
Mailing Address - Country:US
Mailing Address - Phone:510-828-3767
Mailing Address - Fax:
Practice Address - Street 1:1000 BROADWAY STE 500
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4033
Practice Address - Country:US
Practice Address - Phone:510-268-2464
Practice Address - Fax:510-267-3212
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN45629163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management