Healthcare Provider Details

I. General information

NPI: 1194653352
Provider Name (Legal Business Name): FELISA BARBARA M. HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W WASHINGTON BLVD
CRESCENT CITY CA
95531-8340
US

IV. Provider business mailing address

301 W WASHINGTON BLVD
CRESCENT CITY CA
95531-8340
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-6141
  • Fax: 707-464-0238
Mailing address:
  • Phone: 707-464-6141
  • Fax: 707-464-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberCA925C7F06
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: