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General NPI Number Information
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NPI Number | 1356169015
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Entity Type | Individual
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Provider Name | NICOLE HERNANDEZ DPT
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Gender | Female
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 2407 WILSHIRE BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90403-5805
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Country | US
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Telephone | 845-656-4207
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Fax |
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Provider Business Mailing Address
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Address Line | 750 HISTORIC ROUTE 66 SUITE N
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City | GLENDORA
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State | CA
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Zip | 91740
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Country | US
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Telephone | 562-302-6088
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 306793
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License Number State | CA
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