Healthcare Provider Details

I. General information

NPI: 1891333621
Provider Name (Legal Business Name): MRS. SONYA MICHELLE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS SONYA MICHELLE VALENTINE

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 RAMONA VISTA WAY
CARMICHAEL CA
95608
US

IV. Provider business mailing address

5110 RAMONA VISTA WAY
CARMICHAEL CA
95608
US

V. Phone/Fax

Practice location:
  • Phone: 916-214-8365
  • Fax:
Mailing address:
  • Phone: 916-214-8365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: