Individual provider Active NPI

Danielle Elizabeth Fernandes, M.D.

  • Pediatrics Physician
  • Los Angeles, CA
National Provider Identifier
1013228154
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A124996 Issued in CA
Practice address
12555 W Jefferson Blvd Ste 302
Los Angeles, CA 90066-7032
Phone
(424) 443-5600
Fax
(424) 443-5606
NPI assigned
Jun 23, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hematology & Oncology Physician 2080P0207X A124996 CA
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X A124996 CA Primary

Addresses

Primary practice location

12555 W Jefferson Blvd Ste 302
Los Angeles, CA 90066-7032

Mailing address

4650 W Sunset Blvd
Los Angeles, CA 90027-6062

Other practice location 1

4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone (323) 669-2113

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dfernandes1214966@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130720000055 CA Practitioner - Pediatric Medicine 5597906305 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A124996CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Saint Johns Medical Foundation Pediatrics CurrentSince May 1, 2020 Accepting new patients
Saint John'S Health Clinic Past Accepting new patients

Locations

4650 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 361-2122

12555 W Jefferson Blvd
Ste 302
Los Angeles, CA 90066
Phone (424) 443-5600

2121 Santa Monica Blvd
Santa Monica, CA 90404
Phone (310) 281-2024

2336 Santa Monica Blvd
Ste 204
Santa Monica, CA 90404
Phone (310) 453-4477

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1013228154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12555 W JEFFERSON BLVD STE 302",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900667032",
            "telephone_number": "424-443-5600",
            "fax_number": "424-443-5606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4650 W Sunset Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900276062",
            "country_code": "US",
            "telephone_number": "323-669-2113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERNANDES",
        "first_name": "DANIELLE",
        "middle_name": "ELIZABETH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-23",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "CA",
            "license": "A124996",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A124996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dfernandes1214966@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "12555 W Jefferson Blvd Ste 302",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900667032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.