Provider Demographics
NPI:1851567408
Name:FERNANDEZ, ROSIE (RN)
Entity Type:Individual
Prefix:
First Name:ROSIE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 S IMPERIAL AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4243
Mailing Address - Country:US
Mailing Address - Phone:760-312-9817
Mailing Address - Fax:
Practice Address - Street 1:1745 S IMPERIAL AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4243
Practice Address - Country:US
Practice Address - Phone:760-312-9817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497201163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse