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General NPI Number Information
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NPI Number | 1730953910
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Entity Type | Individual
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Provider Name | MARIA GUADALUPE HERNANDEZ P.T. ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 3630 E IMPERIAL HWY
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City | LYNWOOD
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State | CA
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Zip | 90262-2609
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Country | US
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Telephone | 310-900-2776
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Fax |
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Provider Business Mailing Address
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Address Line | 16030 VENTURA BLVD
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City | ENCINO
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State | CA
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Zip | 91436-2731
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Country | US
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Telephone | 732-210-3908
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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 | AT1791
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License Number State | CA
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