Provider Demographics
NPI:1356342638
Name:FERNANDES, INGRID WENDY (MD)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:WENDY
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 C ST
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-3137
Mailing Address - Country:US
Mailing Address - Phone:925-370-5590
Mailing Address - Fax:925-370-5142
Practice Address - Street 1:3052 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2552
Practice Address - Country:US
Practice Address - Phone:925-681-4100
Practice Address - Fax:925-370-5142
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC130373207RG0300X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3896183Medicare ID - Type UnspecifiedMEDICARE
TNI10216Medicare UPIN
TN1356342638Medicare ID - Type Unspecified
TN3896183Medicaid