Provider Demographics
NPI:1851618326
Name:ESTHER A FERMIN MD INC
Entity Type:Organization
Organization Name:ESTHER A FERMIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-245-6455
Mailing Address - Street 1:PO BOX 1280
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-1280
Mailing Address - Country:US
Mailing Address - Phone:760-245-6455
Mailing Address - Fax:760-245-6455
Practice Address - Street 1:15203 11TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:760-245-6455
Practice Address - Fax:760-245-6455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25858207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA86985Medicare UPIN
CA00A258580Medicare PIN