Healthcare Provider Details

I. General information

NPI: 1215864616
Provider Name (Legal Business Name): RUTH ABIGAIL HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S 2ND AVE
COVINA CA
91723-3013
US

IV. Provider business mailing address

535 S 2ND AVE
COVINA CA
91723-3013
US

V. Phone/Fax

Practice location:
  • Phone: 626-214-1480
  • Fax:
Mailing address:
  • Phone: 626-214-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: