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General NPI Number Information
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NPI Number | 1053866517
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Entity Type | Organization
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Legal Business Name | E.WENDY HERNANDEZ, DDS, INC
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 1210 N LONG BEACH BLVD STE 196
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City | COMPTON
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State | CA
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Zip | 90221-1685
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Country | US
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Telephone | 424-785-8708
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Fax | 424-785-8718
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Provider Business Mailing Address
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Address Line | 12920 RUNWAY RD UNIT 310
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City | PLAYA VISTA
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State | CA
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Zip | 90094-2313
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Country | US
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Telephone | 424-785-8708
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Fax | 424-785-8718
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ELSA WENDY HERNANDEZ
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Credential | DDS
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Telephone | 619-251-1312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 56388
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License Number State | CA
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