Provider Demographics
NPI:1235547225
Name:FERNANDEZ, GAYLE S
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:S
Last Name: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 1:1330 S COUNTRYWOOD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6959
Mailing Address - Country:US
Mailing Address - Phone:818-397-7600
Mailing Address - Fax:
Practice Address - Street 1:2502 E. HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2221
Practice Address - Country:US
Practice Address - Phone:626-280-6510
Practice Address - Fax:626-288-1026
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program