Healthcare Provider Details

I. General information

NPI: 1750043998
Provider Name (Legal Business Name): COLLEEN ELAYNE HERNANDEZ MS CHILD DEVELOPMENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8861 WILLIAMSON DR STE 20
ELK GROVE CA
95624-1878
US

IV. Provider business mailing address

8861 WILLIAMSON DR STE 20
ELK GROVE CA
95624-1878
US

V. Phone/Fax

Practice location:
  • Phone: 916-531-8144
  • Fax:
Mailing address:
  • Phone: 916-531-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: