Provider Demographics
NPI:1467171975
Name:FERNANDEZ, ANALISA LYNN (BS)
Entity Type:Individual
Prefix:
First Name:ANALISA
Middle Name:LYNN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 QUAIL VALLEY RUN
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3425
Mailing Address - Country:US
Mailing Address - Phone:510-734-4996
Mailing Address - Fax:
Practice Address - Street 1:1415 QUAIL VALLEY RUN
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-3425
Practice Address - Country:US
Practice Address - Phone:510-734-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY3029153101YM0800X
101YM0800X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10374335OtherKAISER PERMANENTE