Healthcare Provider Details

I. General information

NPI: 1205430097
Provider Name (Legal Business Name): ANNA PATRICIA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WILSHIRE BLVD
LOS ANGELES CA
90010-1577
US

IV. Provider business mailing address

4650 W SUNSET BLVD # 53
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-6675
  • Fax: 323-361-8305
Mailing address:
  • Phone: 323-361-6675
  • Fax: 323-361-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: