Healthcare Provider Details

I. General information

NPI: 1881378925
Provider Name (Legal Business Name): RJ DAVE HERNANDEZ SOLIVEN CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

20764 NASHVILLE ST
CHATSWORTH CA
91311-1522
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-7015
  • Fax:
Mailing address:
  • Phone: 818-730-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number694189
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number4650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: