Healthcare Provider Details

I. General information

NPI: 1871418020
Provider Name (Legal Business Name): ELISA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 N 1ST ST STE 102
FRESNO CA
93710-5450
US

IV. Provider business mailing address

6115 N 1ST ST STE 102
FRESNO CA
93710-5450
US

V. Phone/Fax

Practice location:
  • Phone: 559-229-8200
  • Fax: 559-282-5517
Mailing address:
  • Phone: 559-229-8200
  • Fax: 559-282-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number34044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: