Provider Demographics
NPI:1285691121
Name:FERNANDES, DIONISIO A (MD)
Entity type:Individual
Prefix:DR
First Name:DIONISIO
Middle Name:A
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 1:3448 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1422
Mailing Address - Country:US
Mailing Address - Phone:510-373-3000
Mailing Address - Fax:510-744-9959
Practice Address - Street 1:13847 E 14TH ST.
Practice Address - Street 2:STE 112
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578
Practice Address - Country:US
Practice Address - Phone:510-352-8585
Practice Address - Fax:510-352-8644
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29416207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066330Medicaid
CAGR0066331Medicaid
CAGR0066331Medicaid
CAZZZ82792ZMedicare PIN
CAZZZ82793ZMedicare PIN