Individual
DR. TRACI RACHELLE FERNANDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
901 OAK PARK BLVD STE 203, PISMO BEACH, CA 93449-3410
(805) 489-8232
(805) 489-8234
Mailing address
901 OAK PARK BLVD STE 203, PISMO BEACH, CA 93449-3410
(805) 489-8232
(805) 489-8234
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
41830
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225042120
NPI 2
CA
Enumeration date
04/15/2022
Last updated
04/15/2022
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