Provider Demographics
NPI:1952496499
Name:FERNANDO, RAWINSON D (MD)
Entity Type:Individual
Prefix:DR
First Name:RAWINSON
Middle Name:D
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2281 W 24TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6197
Mailing Address - Country:US
Mailing Address - Phone:928-221-8171
Mailing Address - Fax:
Practice Address - Street 1:2281 W 24TH ST STE 6
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6197
Practice Address - Country:US
Practice Address - Phone:928-221-8171
Practice Address - Fax:928-539-9403
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZB95440Medicare UPIN