Healthcare Provider Details

I. General information

NPI: 1427541622
Provider Name (Legal Business Name): WENDY HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 VETERAN AVE RM 25-27
LOS ANGELES CA
90024-2704
US

IV. Provider business mailing address

1000 VETERAN AVE RM 25-27
LOS ANGELES CA
90024-2704
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-6110
  • Fax:
Mailing address:
  • Phone: 310-825-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: