Healthcare Provider Details

I. General information

NPI: 1205341393
Provider Name (Legal Business Name): DIANA MARITZA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6957 N FIGUEROA ST
LOS ANGELES CA
90042
US

IV. Provider business mailing address

7861 WINNETKA AVE
WINNETKA CA
91306-2350
US

V. Phone/Fax

Practice location:
  • Phone: 323-443-3175
  • Fax: 323-443-3270
Mailing address:
  • Phone: 818-271-0754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: