Provider Demographics
NPI:1639440977
Name:FERNANDEZ, LUIS ALFONSO (MD)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ALFONSO
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-5717
Mailing Address - Country:US
Mailing Address - Phone:650-723-6643
Mailing Address - Fax:650-723-4655
Practice Address - Street 1:401 QUARRY RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-5717
Practice Address - Country:US
Practice Address - Phone:650-723-6643
Practice Address - Fax:650-723-4655
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAA1840522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health