Basic Information
| Provider Information | |||||||||
| NPI: | 1972692093 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDEZ | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20133 PLAZA DE CORDOBA | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907037625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626506424 | ||||||||
| FaxNumber: | 5628658501 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 W 5TH ST STE 590 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927014519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148345015 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY19972 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 1041C0700X | LCS9006 | CA | X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.