Provider Demographics
NPI:1427801984
Name:FERNANDEZ, MARLENE (CSFA)
Entity type:Individual
Prefix:MISS
First Name:MARLENE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 CREEKSIDE WAY APT 1205
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6782
Mailing Address - Country:US
Mailing Address - Phone:239-544-2528
Mailing Address - Fax:
Practice Address - Street 1:580 CREEKSIDE WAY APT 1205
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6782
Practice Address - Country:US
Practice Address - Phone:239-544-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22791363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty