Basic Information
| Provider Information | |||||||||
| NPI: | 1205341393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | MARITZA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7861 WINNETKA AVE | ||||||||
| Address2: | |||||||||
| City: | WINNETKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913062350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182710754 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6957 N FIGUEROA ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234433175 | ||||||||
| FaxNumber: | 3234433270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2017 | ||||||||
| LastUpdateDate: | 05/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.