Provider Demographics
NPI:1861505158
Name:FERNANDEZ, THELMA T (MD)
Entity Type:Individual
Prefix:MRS
First Name:THELMA
Middle Name:T
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 WEST AVENUE J
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-945-2716
Mailing Address - Fax:661-948-0552
Practice Address - Street 1:1601 WEST AVENUE J
Practice Address - Street 2:SUITE 101
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-945-2716
Practice Address - Fax:661-948-0552
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA36169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A361690Medicaid
A27996Medicare UPIN
CA00A361690Medicaid