Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A137644 | CA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | A137644 | CA |
NPI | 1104200575 |
---|---|
Provider Name | Vinay Thomas Fernandes |
First Address | Stanford, CA 94305 |
Second Address | Stanford, CA 94305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2015 |
Last Update Date | 30/07/2015 |