Provider Demographics
NPI:1649923798
Name:FERNANDEZ JOHNSTON, KARMEN N
Entity type:Individual
Prefix:
First Name:KARMEN
Middle Name:N
Last Name:FERNANDEZ JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARMEN
Other - Middle Name:N
Other - Last Name:FILEGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7861
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93006-7861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30300 AGOURA RD STE 195
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-5412
Practice Address - Country:US
Practice Address - Phone:818-532-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129558106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist