Individual
RAUL FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
23072 LAKE CENTER DR STE 115, LAKE FOREST, CA 92630-2880
(949) 528-6822
Mailing address
23072 LAKE CENTER DR STE 115, LAKE FOREST, CA 92630-2880
(949) 528-6822
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-TNFMEP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MPSS-TNFMEP
CALMHSA
CA
Enumeration date
03/21/2025
Last updated
03/21/2025
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