Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A139373 | CA |
N | 2080P0208X | Pediatric Infectious Diseases | A139373 | CA |
NPI | 1437439379 |
---|---|
Provider Name | Priyanka Fernandes |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Santa Clarita, CA 91355-5908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2011 |
Last Update Date | 08/07/2019 |