Provider Demographics
NPI:1174849400
Name:FERNANDO B. FERNANDEZ, DDS APC
Entity type:Organization
Organization Name:FERNANDO B. FERNANDEZ, DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:BARR
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-722-6360
Mailing Address - Street 1:5740 E OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5120
Mailing Address - Country:US
Mailing Address - Phone:323-722-6360
Mailing Address - Fax:323-722-6355
Practice Address - Street 1:5740 E OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-5120
Practice Address - Country:US
Practice Address - Phone:323-722-6360
Practice Address - Fax:323-722-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1621125OtherUNITED CONCORDIA
CA44021OtherPACIFICARE
CA11894501OtherDENTAL BENEFITS PROVIDERS
CA0007225604OtherAETNA
CO130881OtherGUARDIAN
CA7022774OtherUNITED HEALTHCARE
CAB4951701OtherDELTA DENTAL HEALTHY FAMILIES PROGRAM
CAG9314501Medicaid