Provider Demographics
NPI:1801095039
Name:FERNANDO, MARIA CHRISTIE VILLACORTE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA CHRISTIE
Middle Name:VILLACORTE
Last Name:FERNANDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA CHRISTIE
Other - Middle Name:VILLACORTE
Other - Last Name:FERNANDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10200 TRINITY PKWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7286
Mailing Address - Country:US
Mailing Address - Phone:209-943-6740
Mailing Address - Fax:209-943-6744
Practice Address - Street 1:10200 TRINITY PKWY
Practice Address - Street 2:SUITE 207
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7286
Practice Address - Country:US
Practice Address - Phone:209-943-6740
Practice Address - Fax:209-943-6744
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88996208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation