Provider Demographics
NPI:1437568151
Name:FERNANDO, AMORSOLO BALMEO JR
Entity Type:Individual
Prefix:MR
First Name:AMORSOLO
Middle Name:BALMEO
Last Name:FERNANDO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28548 TRIPLE C RANCH RD
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-8432
Mailing Address - Country:US
Mailing Address - Phone:952-249-9698
Mailing Address - Fax:
Practice Address - Street 1:28548 TRIPLE C RANCH RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-8432
Practice Address - Country:US
Practice Address - Phone:952-249-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health