Provider Demographics
NPI:1295247583
Name:FERNANDEZ, MARIA CHRISTINA MENGUITO (MSN, NP)
Entity type:Individual
Prefix:MRS
First Name:MARIA CHRISTINA
Middle Name:MENGUITO
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:4771 S SPAGO DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-6703
Mailing Address - Country:US
Mailing Address - Phone:510-364-9710
Mailing Address - Fax:
Practice Address - Street 1:2435 SAN RAMON VALLEY BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1663
Practice Address - Country:US
Practice Address - Phone:925-905-9912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA690348163W00000X
261QU0200X
CA95004832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care