Healthcare Provider Details

I. General information

NPI: 1891377826
Provider Name (Legal Business Name): GRISELDA HERNANDEZ PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 SAINT ANNE PL
SANTA ANA CA
92707-2115
US

IV. Provider business mailing address

1230 SAINT ANNE PL
SANTA ANA CA
92707-2115
US

V. Phone/Fax

Practice location:
  • Phone: 714-552-5593
  • Fax:
Mailing address:
  • Phone: 714-743-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95028431
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95160424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: