Provider Demographics
NPI:1720750193
Name:FERNANDEZ, MARIA FERNANDA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 LADY BIRD LN APT 329
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-0027
Mailing Address - Country:US
Mailing Address - Phone:830-513-7240
Mailing Address - Fax:
Practice Address - Street 1:5107 S INTERSTATE 35
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-2736
Practice Address - Country:US
Practice Address - Phone:830-513-7240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist