Provider Demographics
NPI:1962580605
Name:FERNANDO, CHRISTINE E (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
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 1:1516 KINGSFORD DR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5967
Mailing Address - Country:US
Mailing Address - Phone:916-485-3428
Mailing Address - Fax:
Practice Address - Street 1:1516 KINGSFORD DR
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-5967
Practice Address - Country:US
Practice Address - Phone:916-485-3428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33155207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A331550Medicaid
00A331550Medicare ID - Type Unspecified
F18337Medicare UPIN