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ANGELITO FERNANDEZ NPI 1700966116


NPI Information

NPI: 1700966116
Provider Name: ANGELITO FERNANDEZ
Classification: Family Medicine - 207Q00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
1506 W REYNOLDS ST
PONTIAC, IL
ZIP 61764
Phone: (815) 844-6123
Get Directions

Angelito Fernandez is a family medicine in Pontiac, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. Angelito Fernandez NPI is 1700966116. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1506 W REYNOLDS ST
PONTIAC, IL
ZIP 61764
Phone: (815) 844-6123
Fax: (815) 884-7851

The NPI 1700966116 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/17/2006 and was last updated on 3/1/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine036-053418ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1D13030MEDICARE UPIN
2080066350MEDICARE ID-TYPE UNSPECIFIEDILLINOISRR INDIVIDUAL #
3036053418MEDICAIDILLINOIS
4CA2182MEDICARE ID-TYPE UNSPECIFIEDILLINOISRR GROUP #
5L36621MEDICARE ID-TYPE UNSPECIFIEDILLINOISINDIVIDUAL #
6080066343MEDICARE ID-TYPE UNSPECIFIEDILLINOISRR INDIVIDUAL #
7833220MEDICARE ID-TYPE UNSPECIFIEDILLINOISGROUP #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

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