Provider Demographics
NPI:1871513457
Name:FERNANDEZ, JESUS FRANCISCO (MD, ABUCM)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:FRANCISCO
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD, ABUCM
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Mailing Address - Street 1:30056 MILANO RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-1636
Mailing Address - Country:US
Mailing Address - Phone:951-316-3416
Mailing Address - Fax:951-699-2148
Practice Address - Street 1:13777 AIR EXPRESSWAY BLVD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-0510
Practice Address - Country:US
Practice Address - Phone:760-246-2552
Practice Address - Fax:760-246-2542
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR10651208D00000X
AKAA2965208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF40482Medicare UPIN