Provider Demographics
NPI:1396178158
Name:FERNANDEZ, GIL LUCAS (RRT, CPFT)
Entity Type:Individual
Prefix:
First Name:GIL
Middle Name:LUCAS
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:RRT, CPFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 MORNING DOVE LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4338
Mailing Address - Country:US
Mailing Address - Phone:909-253-1287
Mailing Address - Fax:
Practice Address - Street 1:1803 MORNING DOVE LN
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4338
Practice Address - Country:US
Practice Address - Phone:909-253-1287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21572227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered