Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003356296 |
---|---|
Provider Name | Ronald Fernandes |
First Address | Eastvale, CA 91752-4378 |
Second Address | Pomona, CA 91767-5406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2017 |
Last Update Date | 07/03/2017 |