Provider Demographics
NPI:1407217292
Name:CHAN-FERNANDEZ, MARLINA
Entity type:Individual
Prefix:
First Name:MARLINA
Middle Name:
Last Name:CHAN-FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 CROSS BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BROAD CHANNEL
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1029
Mailing Address - Country:US
Mailing Address - Phone:917-270-7406
Mailing Address - Fax:
Practice Address - Street 1:550 CROSS BAY BLVD
Practice Address - Street 2:
Practice Address - City:BROAD CHANNEL
Practice Address - State:NY
Practice Address - Zip Code:11693-1029
Practice Address - Country:US
Practice Address - Phone:917-270-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374J00000XNursing Service Related ProvidersDoula