Basic Information
| Provider Information | |||||||||
| NPI: | 1386304103 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | NANCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8835 CANTERBURY AVE | ||||||||
| Address2: | |||||||||
| City: | ARLETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913315801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187485244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 760 MOUNTAIN VIEW ST | ||||||||
| Address2: | |||||||||
| City: | ALTADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910014925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267986793 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2021 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | E3035292 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.