Healthcare Provider Details

I. General information

NPI: 1811374721
Provider Name (Legal Business Name): ANNA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 1ST ST
NAPA CA
94559-2239
US

IV. Provider business mailing address

2310 1ST ST
NAPA CA
94559-2239
US

V. Phone/Fax

Practice location:
  • Phone: 707-255-1855
  • Fax: 707-255-5621
Mailing address:
  • Phone: 707-255-1855
  • Fax: 707-255-5621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: