Individual
GEOVER FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 N PROSPECT AVE, SUITE 302, REDONDO BEACH, CA 90277-3041
(310) 798-1515
(310) 798-3131
Mailing address
520 N PROSPECT AVE, SUITE 302, REDONDO BEACH, CA 90277-3041
(310) 798-1515
(310) 798-3131
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
A103070
CA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
A103070
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00980455
MEDICARE RAILROAD PTAN
CA
Enumeration date
07/10/2006
Last updated
01/02/2013
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