Provider Demographics
NPI:1871504498
Name:FERNANDEZ, GENARO CABAZOS (MD)
Entity type:Individual
Prefix:DR
First Name:GENARO
Middle Name:CABAZOS
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 EUCLID AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950
Mailing Address - Country:US
Mailing Address - Phone:619-267-8181
Mailing Address - Fax:619-479-6750
Practice Address - Street 1:610 EUCLID AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-267-8181
Practice Address - Fax:619-479-6750
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45754207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A457540Medicaid
A45754Medicare ID - Type Unspecified
CA00A457540Medicaid