Provider Demographics
NPI:1861724973
Name:FERNANDEZ, JOSEPH PERALTA (CSA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PERALTA
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-3003
Mailing Address - Country:US
Mailing Address - Phone:507-266-2827
Mailing Address - Fax:
Practice Address - Street 1:201 W CENTER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3003
Practice Address - Country:US
Practice Address - Phone:507-266-2827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3257OtherNATIONAL SURGICAL ASSISTANT ASSOCIATION