Provider Demographics
NPI:1578549788
Name:FERNANDEZ, JANICE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:LYNN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:LYNN
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3626 RUFFIN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1810
Mailing Address - Country:US
Mailing Address - Phone:858-565-9666
Mailing Address - Fax:858-565-9441
Practice Address - Street 1:3626 RUFFIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1810
Practice Address - Country:US
Practice Address - Phone:858-565-9666
Practice Address - Fax:858-565-9441
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85028207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001335373Medicaid
CACB252830Medicare PIN
E95460Medicare UPIN