Provider Demographics
NPI:1851614986
Name:THELMA T FERNANDEZ M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:THELMA T FERNANDEZ M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:T
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-945-2716
Mailing Address - Street 1:1601 W AVENUE J
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2824
Mailing Address - Country:US
Mailing Address - Phone:661-945-2716
Mailing Address - Fax:661-948-0552
Practice Address - Street 1:1601 W AVENUE J
Practice Address - Street 2:SUITE 101
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2824
Practice Address - Country:US
Practice Address - Phone:661-945-2716
Practice Address - Fax:661-948-0552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THELMA T FERNANDEZ M D
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-03
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36169OtherMEDICARE
CA00A361690Medicaid
CA1861505158OtherMEDICARE NPI
CA1861505158OtherMEDICARE NPI