Provider Demographics
NPI:1750180592
Name:FERNANDO, YESNIA AVIGAIL
Entity type:Individual
Prefix:
First Name:YESNIA
Middle Name:AVIGAIL
Last Name:FERNANDO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3861 SEDGWICK AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-5052
Mailing Address - Country:US
Mailing Address - Phone:951-403-4671
Mailing Address - Fax:
Practice Address - Street 1:3861 SEDGWICK AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5052
Practice Address - Country:US
Practice Address - Phone:951-403-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171R00000X
CA0171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter