Healthcare Provider Details

I. General information

NPI: 1588404883
Provider Name (Legal Business Name): ASHLEY CONTRERAS HERNANDEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 W 117TH ST STE 200
HAWTHORNE CA
90250-2240
US

IV. Provider business mailing address

400 N CHAPEL AVE APT 327
ALHAMBRA CA
91801-6030
US

V. Phone/Fax

Practice location:
  • Phone: 310-219-2000
  • Fax:
Mailing address:
  • Phone: 323-407-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: