Healthcare Provider Details

I. General information

NPI: 1487858213
Provider Name (Legal Business Name): LUZ IVETTE NATAL-HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 EUREKA RD MOB 2, PEDIATRIC SUB SPECIALTIES
ROSEVILLE CA
95661-3027
US

IV. Provider business mailing address

1600 EUREKA RD MOB 2, PEDIATRIC SUB SPECIALTIES
ROSEVILLE CA
95661-3027
US

V. Phone/Fax

Practice location:
  • Phone: 916-474-2250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.010551
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA105132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: