Provider Demographics
NPI:1285712190
Name:FERNANDEZ, TONY C (MD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:C
Last Name:FERNANDEZ
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 1:2555 S EAST AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-5104
Mailing Address - Country:US
Mailing Address - Phone:559-499-2400
Mailing Address - Fax:559-264-9241
Practice Address - Street 1:2555 S EAST AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-5104
Practice Address - Country:US
Practice Address - Phone:559-499-2400
Practice Address - Fax:559-264-9241
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA783822083X0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A783820Medicaid
CA00A783820Medicaid
H83039Medicare UPIN