Healthcare Provider Details

I. General information

NPI: 1609215748
Provider Name (Legal Business Name): LIZA NICOLE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 FIRESTONE BLVD SUITE 123
DOWNEY CA
90241
US

IV. Provider business mailing address

7340 FIRESTONE BLVD STE 123
DOWNEY CA
90241-4100
US

V. Phone/Fax

Practice location:
  • Phone: 562-927-5820
  • Fax:
Mailing address:
  • Phone: 562-927-5820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 2579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: