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General NPI Number Information
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NPI Number | 1376570978
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Entity Type | Individual
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Provider Name | CHERISSE MARIE HERNANDEZ A.T.C.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 520 W WALNUT ST
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City | SANTA ANA
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State | CA
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Zip | 92701-5559
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Country | US
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Telephone | 909-910-9157
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Fax | 714-567-4952
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Provider Business Mailing Address
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Address Line | 2900 E LINCOLN AVE APT 223
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City | ANAHEIM
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State | CA
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Zip | 92806-4043
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Country | US
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Telephone | 714-666-8299
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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