Healthcare Provider Details

I. General information

NPI: 1871965574
Provider Name (Legal Business Name): JANIE HERNANDEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD BLDG 4003
SALINAS CA
93906-3100
US

IV. Provider business mailing address

543 LAS CRUCES WAY
SALINAS CA
93901-1722
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4123
  • Fax: 831-755-4033
Mailing address:
  • Phone: 831-682-3991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number627305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: