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General NPI Number Information
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NPI Number | 1225794571
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Entity Type | Individual
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Provider Name | ROSE V HERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 11/11/2021
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 220 W 1ST ST STE 102
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City | SANTA ANA
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State | CA
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Zip | 92701-5262
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Country | US
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Telephone | 714-972-4921
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Fax |
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Provider Business Mailing Address
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Address Line | 2627 W BROADWAY APT 9
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City | ANAHEIM
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State | CA
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Zip | 92804-2173
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Country | US
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Telephone | 562-324-1338
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95025014
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95205281
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License Number State | CA
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