MEDICARE: BECKIE ELAINE HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1033911441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKIE ELAINE HERNANDEZ

Provider Business Mailing Address
First Line	:	146 S MONTE VISTA AVE
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2840
Country	:	US
Telephone Number	:	323-370-5810
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 S MONTE VISTA AVE
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2840
Country	:	US
Telephone Number	:	323-370-5810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	03/26/2025

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