Jacqueline Putsopheak Fernando

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LCSW62661 Issued in CA

Practice address

1134 E Champlain Dr Ste 101-710
Fresno, CA 93720-5033

Phone

(650) 863-8325

NPI assigned

Oct 3, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jacqueline Putsopheak Tak Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1191369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784073600000",
    "number": "1649468695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 E BELLA ROSA AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937307026",
            "telephone_number": "650-863-8325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1134 E CHAMPLAIN DR STE 101-710",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937205033",
            "telephone_number": "650-863-8325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDO",
        "first_name": "JACQUELINE",
        "middle_name": "PUTSOPHEAK",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-03",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "LCSW62661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "TAK",
            "middle_name": "PUTSOPHEAK",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Susana Fernandez
• Susana Renteria Fernandez
• Tony C. Fernandez, MD
• Victor R. Fernandez, MD
• Earl Don Fernando, M.D.
• Elmer Ferraren II
• Ana Gabriela Ferrer Ingram, LVN
• Brenda Ferreyra Ruiz
• Cynthia Ferreyra, PHARMD
• Denise D. Ferriera

• Social Worker in Fresno, CA
• Providers in Fresno, CA by specialty
• Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.