Healthcare Provider Details

I. General information

NPI: 1811807613
Provider Name (Legal Business Name): GEORGETTE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17508 HERCULES ST. SUITE B6
HESPERIA CA
92345
US

IV. Provider business mailing address

PO BOX 401096
HESPERIA CA
92340-1096
US

V. Phone/Fax

Practice location:
  • Phone: 760-488-7971
  • Fax: 760-230-9183
Mailing address:
  • Phone: 760-488-7971
  • Fax: 760-230-9183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: