Healthcare Provider Details

I. General information

NPI: 1447965405
Provider Name (Legal Business Name): GERRY HECHANOVA BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 VERDUGO BLVD
GLENDALE CA
91208-1407
US

IV. Provider business mailing address

2342 ADDISON WAY
LOS ANGELES CA
90041-2604
US

V. Phone/Fax

Practice location:
  • Phone: 818-952-2270
  • Fax:
Mailing address:
  • Phone: 818-438-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95218146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: