Provider Demographics
NPI:1730332669
Name:FERNANDEZ, MARIE ROCHELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ROCHELLE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4539 STANTON DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-5219
Mailing Address - Country:US
Mailing Address - Phone:323-401-3590
Mailing Address - Fax:
Practice Address - Street 1:4539 STANTON DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-5219
Practice Address - Country:US
Practice Address - Phone:323-401-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist