Provider Demographics
NPI:1629039532
Name:FERNANDEZ, RAYMOND C (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:C
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:24221 CALLE DE LA LOUISA
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7638
Mailing Address - Country:US
Mailing Address - Phone:949-588-8700
Mailing Address - Fax:949-465-8159
Practice Address - Street 1:24221 CALLE DE LA LOUISA
Practice Address - Street 2:SUITE 200
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7638
Practice Address - Country:US
Practice Address - Phone:949-465-8155
Practice Address - Fax:949-465-8159
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA042637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A29616Medicare UPIN
CAWA42637CMedicare ID - Type Unspecified