Healthcare Provider Details

I. General information

NPI: 1033926837
Provider Name (Legal Business Name): REBECA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8432 MAGNOLIA AVE
RIVERSIDE CA
92504-3297
US

IV. Provider business mailing address

727 E BASELINE RD
SAN DIMAS CA
91773-1510
US

V. Phone/Fax

Practice location:
  • Phone: 800-782-3382
  • Fax:
Mailing address:
  • Phone: 909-274-8646
  • 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 StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: