Basic Information
| Provider Information | |||||||||
| NPI: | 1922034743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERNANDEZ | ||||||||
| FirstName: | JEFFREY | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 E JEFFERSON ST | ||||||||
| Address2: | STE 400 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981225698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063231900 | ||||||||
| FaxNumber: | 2063236868 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 E JEFFERSON ST | ||||||||
| Address2: | STE 400 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981225698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063231900 | ||||||||
| FaxNumber: | 2063236868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 11/16/2007 | ||||||||
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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 | 363AM0700X | PA10004079 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.