Basic Information
| Provider Information | |||||||||
| NPI: | 1609121136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDEZ | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | MARK ANTONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MBCHB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2056 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941161238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156576225 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 521 PARNASSUS AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941430648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154769035 | ||||||||
| FaxNumber: | 4155141532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2012 | ||||||||
| LastUpdateDate: | 07/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | F 5717 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.