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NPI Code Detail

MEDICARE: AKETZALLI HERNANDEZ

MEDICARE: AKETZALLI 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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1720939408
Entity Type Code : Individual
Provider Name (Legal Business Name) : AKETZALLI HERNANDEZ
Provider Business Mailing Address
First Line : 1808 W ALONDRA BLVD
Second Line :
City : COMPTON
State : CA
Zip : 90220-3536
Country : US
Telephone Number : 323-818-7277
Fax Number :
Provider Business Practice Location Address
First Line : 41550 ECLECTIC ST
Second Line :
City : PALM DESERT
State : CA
Zip : 92260-1967
Country : US
Telephone Number : 877-205-6269
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2026
Last Update Date : 02/07/2026

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Directions to “ AKETZALLI HERNANDEZ ” Practice Location

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