Healthcare Provider Details

I. General information

NPI: 1831305879
Provider Name (Legal Business Name): NANCY SAID HERNANDEZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E VALENCIA MESA DR STE 100
FULLERTON CA
92835-3816
US

IV. Provider business mailing address

12665 GARDEN GROVE BLVD STE 211
GARDEN GROVE CA
92843-1916
US

V. Phone/Fax

Practice location:
  • Phone: 714-992-5581
  • Fax:
Mailing address:
  • Phone: 714-636-2890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number20A9829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: