Healthcare Provider Details

I. General information

NPI: 1457285553
Provider Name (Legal Business Name): RAQUEL HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 GENESEE AVE STE 102
SAN DIEGO CA
92117-4986
US

IV. Provider business mailing address

3459 PASEO DE ALICIA UNIT 21
OCEANSIDE CA
92056-4164
US

V. Phone/Fax

Practice location:
  • Phone: 619-207-0984
  • Fax: 619-207-0861
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number9503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: