Healthcare Provider Details

I. General information

NPI: 1063776128
Provider Name (Legal Business Name): JUDY HERNANDEZ PEDRO RN, MSN, PHN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E 19TH ST
BAKERSFIELD CA
93305-5406
US

IV. Provider business mailing address

1800 MOUNT VERNON AVE
BAKERSFIELD CA
93306-3302
US

V. Phone/Fax

Practice location:
  • Phone: 661-631-5895
  • Fax: 661-631-5898
Mailing address:
  • Phone: 661-868-0502
  • Fax: 661-868-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number589688
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN589688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: