Healthcare Provider Details

I. General information

NPI: 1861958928
Provider Name (Legal Business Name): ELIZABETH HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/02/2026
Certification Date: 01/22/2026
Deactivation Date: 01/22/2026
Reactivation Date: 02/02/2026

III. Provider practice location address

5834 ADENMOOR AVE
LAKEWOOD CA
90713-1002
US

IV. Provider business mailing address

333 S BEAUDRY AVE
LOS ANGELES CA
90017-1466
US

V. Phone/Fax

Practice location:
  • Phone: 949-756-8799
  • Fax:
Mailing address:
  • Phone: 213-241-3840
  • Fax: 213-241-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number2D7424ECF
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: