Healthcare Provider Details

I. General information

NPI: 1215547856
Provider Name (Legal Business Name): LORI HERNANDEZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 N TORREY PINES RD
LA JOLLA CA
92037-1035
US

IV. Provider business mailing address

1266 VISTA DEL MONTE DR
EL CAJON CA
92020-6830
US

V. Phone/Fax

Practice location:
  • Phone: 858-964-1011
  • Fax:
Mailing address:
  • Phone: 619-846-4097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number47313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: