Provider Demographics
NPI:1831487123
Name:FERNANDEZ, ROSALIE P (PSYCHIATRIC TECH)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:P
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PSYCHIATRIC TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 MARIA WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-5045
Mailing Address - Country:US
Mailing Address - Phone:805-603-8655
Mailing Address - Fax:
Practice Address - Street 1:1211 MARIA WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5045
Practice Address - Country:US
Practice Address - Phone:805-603-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27196247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT27196OtherPSYCHIATRIC TECHNICIAN