Basic Information
| Provider Information | |||||||||
| NPI: | 1811380322 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERNANDEZ | ||||||||
| FirstName: | GABRIEL | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2024 E COMMONWEALTH AVE | ||||||||
| Address2: | APT C | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928314841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106486377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7212 ORANGETHORPE AVE | ||||||||
| Address2: | SUITE 9A | ||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906213341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145036550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2015 | ||||||||
| LastUpdateDate: | 01/18/2017 | ||||||||
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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 | 163W00000X | 738583 | CA | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 95001941 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.