Healthcare Provider Details

I. General information

NPI: 1346104452
Provider Name (Legal Business Name): KAROL HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE SEAHAWK WAY REDONDO BEACH CA 90277
REDONDO BEACH CA
90277
US

IV. Provider business mailing address

ONE SEAHAWK WAY REDONDO BEACH CA 90277
REDONDO BEACH CA
90277
US

V. Phone/Fax

Practice location:
  • Phone: 310-798-8665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberA2BB1710AC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: