Provider Demographics
NPI:1528010204
Name:FERNANDO, IRENE RODRIGUEZ (NP)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:RODRIGUEZ
Last Name:FERNANDO
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Gender:F
Credentials:NP
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Mailing Address - Street 1:393 E WALNUT ST
Mailing Address - Street 2:FL 3
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:877-608-0044
Mailing Address - Fax:877-514-0903
Practice Address - Street 1:1526 N EDGEMONT ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5260
Practice Address - Country:US
Practice Address - Phone:323-783-4595
Practice Address - Fax:323-783-6134
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2021-11-23
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Provider Licenses
StateLicense IDTaxonomies
CA589336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily