Provider Demographics
NPI:1649419649
Name:FENDER, CLAUDIA IRENE
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:IRENE
Last Name:FENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W LODI AVE STE G2
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3037
Mailing Address - Country:US
Mailing Address - Phone:209-956-4240
Mailing Address - Fax:
Practice Address - Street 1:1300 W LODI AVE STE G2
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3037
Practice Address - Country:US
Practice Address - Phone:209-956-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)