Healthcare Provider Details

I. General information

NPI: 1285872267
Provider Name (Legal Business Name): KELLI LEILANI HERNANDEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLI LEILANI MORIGUCHI

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 W OLIVE AVE
BURBANK CA
91506-2216
US

IV. Provider business mailing address

1218 W OLIVE AVE
BURBANK CA
91506-2216
US

V. Phone/Fax

Practice location:
  • Phone: 818-845-2255
  • Fax:
Mailing address:
  • Phone: 818-845-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022712
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: