=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548859895
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICIA HERNANDEZ ENCINAS NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2021
-----------------------------------------------------
Last Update Date | 11/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12898 TOWNE CENTER DR
-----------------------------------------------------
City | CERRITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90703-8546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-677-2470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6315 W VELVET SENNA DR
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85757-7518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-405-2395
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RNP252208
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------