Healthcare Provider Details

I. General information

NPI: 1669954129
Provider Name (Legal Business Name): RACHEL CLEONA HERNANDEZ RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 214TH ST SE STE 300
BOTHELL WA
98021-4418
US

IV. Provider business mailing address

1909 214TH ST SE STE 300
BOTHELL WA
98021-4418
US

V. Phone/Fax

Practice location:
  • Phone: 425-412-7200
  • Fax:
Mailing address:
  • Phone: 425-412-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-1065
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI61478158
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: