Healthcare Provider Details

I. General information

NPI: 1891538187
Provider Name (Legal Business Name): SHARON JUSTINE DIZON HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12433 LAMBERT RD
WHITTIER CA
90606-2770
US

IV. Provider business mailing address

12433 LAMBERT RD
WHITTIER CA
90606-2770
US

V. Phone/Fax

Practice location:
  • Phone: 626-824-0289
  • Fax:
Mailing address:
  • Phone: 844-877-4648
  • Fax: 714-276-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95030103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: