Basic Information
| Provider Information | |||||||||
| NPI: | 1710448303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDEZ ARCE | ||||||||
| FirstName: | OSCAR | ||||||||
| MiddleName: | FABIAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1644 259TH ST APT A | ||||||||
| Address2: | |||||||||
| City: | HARBOR CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907103290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195041390 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1403 LOMITA BLVD FL 2 | ||||||||
| Address2: | |||||||||
| City: | HARBOR CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907102076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106022550 | ||||||||
| FaxNumber: | 3103267205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2019 | ||||||||
| LastUpdateDate: | 03/27/2019 | ||||||||
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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 | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.