Healthcare Provider Details

I. General information

NPI: 1043995541
Provider Name (Legal Business Name): DONNA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23461 SOUTH POINTE DR SUITE 220
LAGUNA HILLS CA
92653
US

IV. Provider business mailing address

23461 SOUTH POINTE DR SUITE 220
LAGUNA HILLS CA
92653
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-1556
  • Fax:
Mailing address:
  • Phone: 949-855-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: