Provider Demographics
NPI:1346254380
Name:MENDEZ-FERNANDEZ, MIGUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:MENDEZ-FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2439 SONOMA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3026
Mailing Address - Country:US
Mailing Address - Phone:530-241-1300
Mailing Address - Fax:530-241-0200
Practice Address - Street 1:2439 SONOMA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3026
Practice Address - Country:US
Practice Address - Phone:530-241-1300
Practice Address - Fax:530-241-0200
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC41376208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C413760Medicaid
CA00C413760Medicaid
CAD66977Medicare UPIN