1700014420 NPI number — MRS. CHRISTINA MICHELLE FERNANDEZ M.S., SLP, CCC

Table of content: MRS. CHRISTINA MICHELLE FERNANDEZ M.S., SLP, CCC (NPI 1700014420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700014420 NPI number — MRS. CHRISTINA MICHELLE FERNANDEZ M.S., SLP, CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDEZ
Provider First Name:
CHRISTINA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., SLP, CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIMASSI
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., SLP, CCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700014420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10350 W MCDOWELL RD APT 2154
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVONDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85392-4820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-513-3933
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32531 N SCOTTSDALE RD STE 105-162
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85266-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-488-3946
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2009

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: 235Z00000X , with the licence number:  SLP5994 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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