Provider Demographics
NPI:1487819629
Name:FERNANDES, SANDRA VITORIA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:VITORIA
Last Name:FERNANDES
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 1:642 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-4718
Mailing Address - Country:US
Mailing Address - Phone:209-985-1139
Mailing Address - Fax:209-205-1062
Practice Address - Street 1:642 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4718
Practice Address - Country:US
Practice Address - Phone:209-985-1139
Practice Address - Fax:209-205-1062
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional