Provider Demographics
NPI:1811712185
Name:FERNANDEZ, CARLOS (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 LAINE ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-1822
Mailing Address - Country:US
Mailing Address - Phone:408-477-4799
Mailing Address - Fax:
Practice Address - Street 1:40 PENNY LN STE 4
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6008
Practice Address - Country:US
Practice Address - Phone:831-763-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT292092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist