Provider Demographics
NPI:1891143111
Name:FERNANDEZ, RAYMOND (MFTI)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6957 N FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-1245
Mailing Address - Country:US
Mailing Address - Phone:323-443-3175
Mailing Address - Fax:323-443-3162
Practice Address - Street 1:6957 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-1245
Practice Address - Country:US
Practice Address - Phone:323-443-3175
Practice Address - Fax:323-443-3162
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF75386106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist