Provider Demographics
NPI:1275512121
Name:FERNANDO, ANTONIO CARMONA (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:CARMONA
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2658
Mailing Address - Country:US
Mailing Address - Phone:610-831-8086
Mailing Address - Fax:610-831-8087
Practice Address - Street 1:305 2ND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2658
Practice Address - Country:US
Practice Address - Phone:610-831-8086
Practice Address - Fax:610-831-8087
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA5712L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor