Provider Demographics
NPI:1598491037
Name:FERNANDEZ, MINETT (HSC)
Entity Type:Individual
Prefix:
First Name:MINETT
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:HSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3515
Mailing Address - Country:US
Mailing Address - Phone:253-428-8431
Mailing Address - Fax:253-552-5631
Practice Address - Street 1:1149 MARKET ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3515
Practice Address - Country:US
Practice Address - Phone:253-428-8431
Practice Address - Fax:253-552-5631
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator