Healthcare Provider Details

I. General information

NPI: 1568354306
Provider Name (Legal Business Name): ELIANA VALENCIA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 CENTER COURT DR
COVINA CA
91724-3627
US

IV. Provider business mailing address

4740 N GRAND AVE
COVINA CA
91724-2005
US

V. Phone/Fax

Practice location:
  • Phone: 626-859-2089
  • Fax: 626-331-3190
Mailing address:
  • Phone: 626-859-2089
  • Fax: 626-331-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: