Provider Demographics
NPI:1811380322
Name:FERNANDEZ, GABRIEL (NP)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 E COMMONWEALTH AVE
Mailing Address - Street 2:APT C
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4841
Mailing Address - Country:US
Mailing Address - Phone:510-648-6377
Mailing Address - Fax:
Practice Address - Street 1:7212 ORANGETHORPE AVE
Practice Address - Street 2:SUITE 9A
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3341
Practice Address - Country:US
Practice Address - Phone:714-503-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-07
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA738583163W00000X
CA95001941363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse