Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95004318 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95004318 | CA |
NPI | 1013451731 |
---|---|
Provider Name | Maria Fatima Georgia Fernandez Misa |
First Address | Los Angeles, CA 90042-3428 |
Second Address | Los Angeles, CA 90042-3428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2016 |
Last Update Date | 26/04/2018 |