Provider Demographics
NPI:1437363462
Name:FERNANDEZ, MARIA ESTHER (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ESTHER
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:3175 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2951
Mailing Address - Country:US
Mailing Address - Phone:323-567-8910
Mailing Address - Fax:323-923-5460
Practice Address - Street 1:3175 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2951
Practice Address - Country:US
Practice Address - Phone:323-567-8910
Practice Address - Fax:323-923-5460
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12307363A00000X
CAPA12307364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437363462OtherNPI