Provider Demographics
NPI:1316656812
Name:FERNANDEZ, NANCY MIREYA (NPI)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:MIREYA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:NPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 E. GRANGER AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-558-4610
Mailing Address - Fax:209-558-4590
Practice Address - Street 1:800 SCENIC DR BLDG E
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6131
Practice Address - Country:US
Practice Address - Phone:209-558-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist