Provider Demographics
NPI:1316909674
Name:FERNANDEZ, YOCASTA (MD)
Entity type:Individual
Prefix:DR
First Name:YOCASTA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
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:PO BOX 667
Mailing Address - Street 2:KINDCARE PEDIATRICS LLC
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-0667
Mailing Address - Country:US
Mailing Address - Phone:973-574-8688
Mailing Address - Fax:973-249-8799
Practice Address - Street 1:287 MONROE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5209
Practice Address - Country:US
Practice Address - Phone:973-574-8688
Practice Address - Fax:973-249-8799
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA077362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0039586Medicaid