Basic Information
| Provider Information | |||||||||
| NPI: | 1376822601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDEZ | ||||||||
| FirstName: | KHALILAH | ||||||||
| MiddleName: | TOINYA | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 334 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920205207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197158107 | ||||||||
| FaxNumber: | 6192860060 | ||||||||
| Practice Location | |||||||||
| Address1: | 4974 EL CAJON BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921154677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192864600 | ||||||||
| FaxNumber: | 6192860060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2011 | ||||||||
| LastUpdateDate: | 08/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN259223 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.