Provider Demographics
NPI:1366026999
Name:FERNANDES, KATRINA (FNP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5962 SERENA ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3606
Mailing Address - Country:US
Mailing Address - Phone:805-231-0744
Mailing Address - Fax:
Practice Address - Street 1:301 SCIENCE DR STE 150
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2097
Practice Address - Country:US
Practice Address - Phone:805-955-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013773208D00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner