Provider Demographics
NPI:1376691980
Name:FERNANDEZ, MONICA
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:
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 1:1917 SUNNYCREST DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3626
Mailing Address - Country:US
Mailing Address - Phone:714-871-0632
Mailing Address - Fax:714-447-4408
Practice Address - Street 1:1917 SUNNYCREST DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3626
Practice Address - Country:US
Practice Address - Phone:714-871-0632
Practice Address - Fax:714-447-4408
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7009237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist