Healthcare Provider Details

I. General information

NPI: 1245118462
Provider Name (Legal Business Name): MS. KARLA CAMILA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 03/16/2026
Certification Date: 08/25/2025
Deactivation Date: 08/25/2025
Reactivation Date: 03/16/2026

III. Provider practice location address

3550 LOGAN AVE
SAN DIEGO CA
92113-2712
US

IV. Provider business mailing address

2351 CARDINAL LN
SAN DIEGO CA
92123-3743
US

V. Phone/Fax

Practice location:
  • Phone: 619-344-6210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number3D8A08F056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: