Provider Demographics
NPI:1497127278
Name:FERNANDEZ, XIOMARA ALEXIS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:XIOMARA
Middle Name:ALEXIS
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N SAN VICENTE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2303
Mailing Address - Country:US
Mailing Address - Phone:310-870-0400
Mailing Address - Fax:
Practice Address - Street 1:155 N SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2303
Practice Address - Country:US
Practice Address - Phone:310-870-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019239363A00000X
CA58185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant