Provider Demographics
NPI:1972513703
Name:FERNANDEZ, RENEE
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name: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 1:1929 S ARIZONA AVE
Mailing Address - Street 2:STE 8
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-5721
Mailing Address - Country:US
Mailing Address - Phone:928-783-0722
Mailing Address - Fax:928-783-6701
Practice Address - Street 1:1929 S ARIZONA AVE
Practice Address - Street 2:STE 8
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-5721
Practice Address - Country:US
Practice Address - Phone:928-783-0722
Practice Address - Fax:928-783-6701
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies