Provider Demographics
NPI:1518011410
Name:FERNANDEZ, LORI MARIE (RD,CNSD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MARIE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RD,CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 KIELY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5329
Mailing Address - Country:US
Mailing Address - Phone:408-236-4257
Mailing Address - Fax:
Practice Address - Street 1:900 KIELY BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5329
Practice Address - Country:US
Practice Address - Phone:408-236-4257
Practice Address - Fax:408-236-4973
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric