Healthcare Provider Details

I. General information

NPI: 1568818789
Provider Name (Legal Business Name): IRMA HERNANDEZ SOTO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRMA HERNANDEZ NP

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 12/22/2023
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11285 MOUNTAIN VIEW AVE 40
LOMA LINDA CA
92354-3862
US

IV. Provider business mailing address

15443 OLD CASTLE RD
FONTANA CA
92337-0909
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-5844
  • Fax: 909-558-3168
Mailing address:
  • Phone: 909-275-0416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95003989
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number814787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: