Provider Demographics
NPI:1609963156
Name:RJ FERNANDEZ MD INC APC.
Entity Type:Organization
Organization Name:RJ FERNANDEZ MD INC APC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MD
Authorized Official - Prefix:MR
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:FERNANDEZ. M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-476-9054
Mailing Address - Street 1:450 4TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4428
Mailing Address - Country:US
Mailing Address - Phone:619-476-9054
Mailing Address - Fax:619-476-9056
Practice Address - Street 1:450 4TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4428
Practice Address - Country:US
Practice Address - Phone:619-476-9054
Practice Address - Fax:619-476-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A444410Medicaid
CA1366539793OtherNPI
CA1366539793OtherNPI