Provider Demographics
NPI:1942235304
Name:FERNANDEZ, MICHAEL EDWARD (AT,C , PTA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:AT,C , PTA
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Other - Middle Name:
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Mailing Address - Street 1:1351 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4569
Mailing Address - Country:US
Mailing Address - Phone:714-957-3781
Mailing Address - Fax:714-641-3698
Practice Address - Street 1:1202 W EDINGER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-2126
Practice Address - Country:US
Practice Address - Phone:714-957-3781
Practice Address - Fax:714-641-3698
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer