Provider Demographics
NPI:1861456980
Name:FERNANDEZ, EDGAR J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11100 WARNER AVE
Mailing Address - Street 2:SUITE #320A
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7506
Mailing Address - Country:US
Mailing Address - Phone:714-545-1938
Mailing Address - Fax:714-545-1460
Practice Address - Street 1:11100 WARNER AVE
Practice Address - Street 2:SUITE #320A
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7506
Practice Address - Country:US
Practice Address - Phone:714-545-1938
Practice Address - Fax:714-545-1460
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2008-07-30
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Provider Licenses
StateLicense IDTaxonomies
CAA31698208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC35391Medicare UPIN