Provider Demographics
NPI:1750593349
Name:FERNANDO, ELIZA MARIE (MD)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:MARIE
Last Name:FERNANDO
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 1:13444 DARVALLE ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6323
Mailing Address - Country:US
Mailing Address - Phone:562-229-0905
Mailing Address - Fax:
Practice Address - Street 1:12444 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1005
Practice Address - Country:US
Practice Address - Phone:562-698-0161
Practice Address - Fax:562-698-8740
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61717208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics