Basic Information
| Provider Information | |||||||||
| NPI: | 1003297698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDEZ | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6171 W CHARLESTON BLVD BLDG 7 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891461126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024867581 | ||||||||
| FaxNumber: | 7024867576 | ||||||||
| Practice Location | |||||||||
| Address1: | 6171 W CHARLESTON BLVD BLDG 7 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891461126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024867581 | ||||||||
| FaxNumber: | 7024867576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2015 | ||||||||
| LastUpdateDate: | 07/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | NV | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | IC-1979 | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.