Healthcare Provider Details

I. General information

NPI: 1124817101
Provider Name (Legal Business Name): NATALIE HERNANDEZ RT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 REYNOLDS RD
RIVERSIDE CA
92503-3517
US

IV. Provider business mailing address

4186 JONES AVE
RIVERSIDE CA
92505-2903
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4466
  • Fax:
Mailing address:
  • Phone: 951-275-4725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: