Provider Demographics
NPI:1871688739
Name:FERNANDEZ, MARINO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINO
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 N FRESNO ST
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5269
Mailing Address - Country:US
Mailing Address - Phone:559-449-4350
Mailing Address - Fax:559-449-4358
Practice Address - Street 1:6235 N FRESNO ST
Practice Address - Street 2:SUITE # 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5269
Practice Address - Country:US
Practice Address - Phone:559-449-4350
Practice Address - Fax:559-449-4358
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51029207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ71868ZMedicaid
CAP01598623Medicare PIN
CAZZZ71868ZMedicare ID - Type Unspecified
CAHE260ZMedicare PIN
CAZZZ71868ZMedicaid