Healthcare Provider Details

I. General information

NPI: 1053998971
Provider Name (Legal Business Name): LORENA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 N 31ST AVE STE 126
PHOENIX AZ
85051-9599
US

IV. Provider business mailing address

10240 N 31ST AVE STE 126
PHOENIX AZ
85051-9599
US

V. Phone/Fax

Practice location:
  • Phone: 602-635-3860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA15314
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: