Provider Demographics
NPI:1689050239
Name:FERNANDEZ, JEAN LOUISE LERIT
Entity Type:Individual
Prefix:
First Name:JEAN LOUISE
Middle Name:LERIT
Last Name:FERNANDEZ
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 1:1576 BELDEN CT
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2463
Mailing Address - Country:US
Mailing Address - Phone:510-734-2727
Mailing Address - Fax:
Practice Address - Street 1:1576 BELDEN CT
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2463
Practice Address - Country:US
Practice Address - Phone:510-734-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262910164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse