MEDICARE: BERTHA 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	163W00000X	Registered Nurse	552273	CA

General Provider Information

NPI Number	:	1972675056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERTHA HERNANDEZ

Provider Business Mailing Address
First Line	:	1419 S SPRUCE ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-3731
Country	:	US
Telephone Number	:	714-432-7786
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 S SPRUCE ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-3731
Country	:	US
Telephone Number	:	714-432-7786
Fax Number	:

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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Directions to “ BERTHA HERNANDEZ ” Practice Location

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