Healthcare Provider Details

I. General information

NPI: 1801709159
Provider Name (Legal Business Name): MIRANDA YVETTE HERNANDEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E DEL MAR BLVD
PASADENA CA
91107-4399
US

IV. Provider business mailing address

1412 BIRCH ST
MONTEBELLO CA
90640-6405
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-9901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95348692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: