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General NPI Number Information
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NPI Number | 1104016104
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Entity Type | Individual
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Provider Name | MAYRA MARLEN HERNANDEZ RN
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Gender | Female
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 3831 HUGHES AVE SUITE 604
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City | CULVER CITY
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State | CA
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Zip | 90232-2751
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Country | US
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Telephone | 310-839-4381
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Fax | 310-815-2091
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Provider Business Mailing Address
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Address Line | 217 W 113TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90061-1911
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Country | US
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Telephone | 323-733-1885
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Fax | 323-733-1875
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN 566430
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License Number State | CA
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