Provider Demographics
NPI:1750154993
Name:FERNANDEZ, ABIGAIL MARIE JAGOLINO (OD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MARIE JAGOLINO
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 EVANS ST APT SUITE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5666
Mailing Address - Country:US
Mailing Address - Phone:714-519-8630
Mailing Address - Fax:
Practice Address - Street 1:1200 ARTESIA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2755
Practice Address - Country:US
Practice Address - Phone:310-372-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist