Provider Demographics
NPI:1770872897
Name:FERNANDEZ, MARYBELL M (RN)
Entity type:Individual
Prefix:MRS
First Name:MARYBELL
Middle Name:M
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARYBELL
Other - Middle Name:M
Other - Last Name:FERNANDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3619
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:625 HILBY AVE
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5720
Practice Address - Country:US
Practice Address - Phone:831-583-6700
Practice Address - Fax:831-394-1870
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA777990163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse