Healthcare Provider Details

I. General information

NPI: 1447721147
Provider Name (Legal Business Name): AMANDA LEIGH HERNANDEZ RENDON RCP RRT-NPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LEIGH HERNANDEZ RENDON

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 EUREKA RD
ROSEVILLE CA
95661-3027
US

IV. Provider business mailing address

1600 EUREKA RD
ROSEVILLE CA
95661-3027
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-5427
  • Fax:
Mailing address:
  • Phone: 916-784-5427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number29146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: