MEDICARE: JHYRE HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1639732225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JHYRE HERNANDEZ

Provider Business Mailing Address
First Line	:	669 W. 34TH ST.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0411
Country	:	US
Telephone Number	:	213-821-5977
Fax Number	:

Provider Business Practice Location Address
First Line	:	669 W 34TH ST STE 102M
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0411
Country	:	US
Telephone Number	:	213-821-5977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	08/02/2023

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Directions to “ JHYRE HERNANDEZ ” Practice Location

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