Individual
EARVIN JAY FERNANDEZ TANEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2640 MARTIN LUTHER KING JR WAY, BERKELEY, CA 94704-3238
(510) 714-0996
Mailing address
6522 TELEGRAPH AVE, OAKLAND, CA 94609-1114
(510) 714-0996
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
08/05/2024
Last updated
08/05/2024
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