1548483415 NPI number — MS. KATHLEEN A FERNANDEZ C.A.S.

Table of content: MS. KATHLEEN A FERNANDEZ C.A.S. (NPI 1548483415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548483415 NPI number — MS. KATHLEEN A FERNANDEZ C.A.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDEZ
Provider First Name:
KATHLEEN
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
C.A.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PEPIN
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.A.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548483415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10164 SWANTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92071-1063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-729-5454
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7841 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-3709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-697-2388
Provider Business Practice Location Address Fax Number:
619-697-2038
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  01-056936 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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