Individual
DR. ELISE K FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
12121 WILSHIRE BLVD STE 1111, LOS ANGELES, CA 90025-1188
(310) 409-4265
(310) 820-0588
Mailing address
915 N LA BREA AVE APT 368, WEST HOLLYWOOD, CA 90038-2363
(305) 972-5122
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
103272
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103272
—
CA
Enumeration date
10/17/2018
Last updated
10/17/2018
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