Provider Demographics
NPI:1538283551
Name:FERNANDEZ, ILANA ALANEO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ILANA
Middle Name:ALANEO
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-0784
Mailing Address - Country:US
Mailing Address - Phone:808-783-4404
Mailing Address - Fax:
Practice Address - Street 1:50 CALASA RD
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8101
Practice Address - Country:US
Practice Address - Phone:808-262-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY - 959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical