Provider Demographics
NPI:1598187080
Name:FERNANDEZ, NATALIA MICHELLE (MS)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:MICHELLE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0911
Mailing Address - Country:US
Mailing Address - Phone:909-387-7000
Mailing Address - Fax:909-387-7611
Practice Address - Street 1:900 E GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0911
Practice Address - Country:US
Practice Address - Phone:909-387-7000
Practice Address - Fax:909-387-7611
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113137106H00000X
171M00000X, 390200000X
CA94281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program