Individual
ANGELITO FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1506 W REYNOLDS ST, PONTIAC, IL 61764
(815) 844-6123
(815) 884-7851
Mailing address
1506 W REYNOLDS ST, PONTIAC, IL 61764
(815) 844-6123
(815) 884-7851
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-053418
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053418
—
IL
Enumeration date
10/17/2006
Last updated
03/01/2011
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