Provider Demographics
NPI:1891552873
Name:FERNANDEZ SANTIESTEBAN, VICTOR H
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:H
Last Name:FERNANDEZ SANTIESTEBAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8022 N 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-6302
Mailing Address - Country:US
Mailing Address - Phone:602-513-3616
Mailing Address - Fax:
Practice Address - Street 1:8022 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6302
Practice Address - Country:US
Practice Address - Phone:602-513-3616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical