Provider Demographics
NPI:1518666981
Name:FERNANDEZ, CARLA VERONICA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:VERONICA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 W VALLEY BLVD APT 528
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2249
Mailing Address - Country:US
Mailing Address - Phone:951-236-3296
Mailing Address - Fax:
Practice Address - Street 1:3950 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3517
Practice Address - Country:US
Practice Address - Phone:833-391-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95166005163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult