Provider Demographics
NPI:1326052887
Name:FERNANDEZ, ERIC LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LOUIS
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 BALBOA BLVD 150
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5810
Mailing Address - Country:US
Mailing Address - Phone:818-637-2000
Mailing Address - Fax:818-654-3417
Practice Address - Street 1:26357 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4488
Practice Address - Country:US
Practice Address - Phone:661-222-2605
Practice Address - Fax:661-222-2660
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A608640Medicaid
CAG90530Medicare UPIN
CA00A608640Medicaid