Provider Demographics
NPI:1215911763
Name:FERNANDES, COLIN LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:LOUIS
Last Name:FERNANDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 ALMA AVE
Mailing Address - Street 2:APT E416
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5031
Mailing Address - Country:US
Mailing Address - Phone:925-256-8662
Mailing Address - Fax:
Practice Address - Street 1:150 MUIR RD
Practice Address - Street 2:112/A
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4668
Practice Address - Country:US
Practice Address - Phone:925-372-2620
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214137207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine