Healthcare Provider Details

I. General information

NPI: 1760621965
Provider Name (Legal Business Name): SOPHIA HERNANDEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CAMPUS DR
HANFORD CA
93230
US

IV. Provider business mailing address

4411 E KINGS CANYON RD APT 104
FRESNO CA
93702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-3211
  • Fax:
Mailing address:
  • Phone: 559-453-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number73872
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number565438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: