Provider Demographics
NPI:1336625821
Name:FERNANDEZ, JOHN KENNETH CHECA
Entity Type:Individual
Prefix:
First Name:JOHN KENNETH
Middle Name:CHECA
Last Name:FERNANDEZ
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 1:1000 CAYUGA AVE RM 156
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3236
Mailing Address - Country:US
Mailing Address - Phone:415-469-4512
Mailing Address - Fax:415-337-2175
Practice Address - Street 1:1000 CAYUGA AVE RM 156
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3236
Practice Address - Country:US
Practice Address - Phone:415-469-4512
Practice Address - Fax:415-337-2175
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC6979101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional