Provider Demographics
NPI:1700014420
Name:FERNANDEZ, CHRISTINA MICHELLE (MS, SLP, CCC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MICHELLE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MS, SLP, CCC
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:MICHELLE
Other - Last Name:MIMASSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SLP, CCC
Mailing Address - Street 1:10350 W MCDOWELL RD APT 2154
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4820
Mailing Address - Country:US
Mailing Address - Phone:602-513-3933
Mailing Address - Fax:
Practice Address - Street 1:32531 N SCOTTSDALE RD STE 105-162
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-1519
Practice Address - Country:US
Practice Address - Phone:480-488-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5994235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist