Active NPI
Vivian Fernandez
- General Practice Dentistry
- Elk Grove, CA
National Provider Identifier
1124165261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 54142
- Practice address
- 9340 W Stockton Blvd
Elk Grove, CA 95758-8014 - Phone
- (916) 683-5732
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 54142 | CA | Primary |
Addresses
Primary practice location
9340 W Stockton Blvd
Elk Grove, CA 95758-8014
Mailing address
9320 Elk Grove Blvd Ste 170
Elk Grove, CA 95624-5061
Phone (916) 714-5422
Other practice location 1
9320 Elk Grove Blvd Ste 170
Elk Grove, CA 95624-5061
Phone (916) 714-5422
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D54142 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54142 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vivian Fernandez DDS.Inc | General Practice | Current | Accepting new patients |
Locations
9320 Elk Grove Blvd
Ste 170
Elk Grove, CA 95624
Phone (916) 714-5422
Organizations & group practices 1
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": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687219200000",
"number": "1124165261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9320 ELK GROVE BLVD STE 170",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956245061",
"telephone_number": "916-714-5422",
"fax_number": "916-714-5429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9340 W STOCKTON BLVD",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957588014",
"telephone_number": "916-683-5732"
}
],
"practiceLocations": [
{
"address_1": "9320 Elk Grove Blvd Ste 170",
"address_purpose": "LOCATION",
"city": "Elk Grove",
"state": "CA",
"postal_code": "956245061",
"country_code": "US",
"telephone_number": "916-714-5422",
"fax_number": "916-714-5429",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FERNANDEZ",
"first_name": "VIVIAN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-30",
"last_updated": "2023-06-20",
"certification_date": "2023-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "54142",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D54142",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.