1043612526 NPI number — EDGAR E. FERNANDEZ MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043612526 NPI number — EDGAR E. FERNANDEZ MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDGAR E. FERNANDEZ MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043612526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 GATEWAY BLVD W STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79925-3315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-779-1716
Provider Business Mailing Address Fax Number:
915-779-1754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1512 ZARAGOZA ROAD
Provider Second Line Business Practice Location Address:
BUILDING C STE 3-4
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79936-8903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-206-2120
Provider Business Practice Location Address Fax Number:
915-206-2130
Provider Enumeration Date:
09/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
EDGAR
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
915-274-4082

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  Q0045 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com