MEDICARE: DENISSE MARIE 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	171M00000X	Case Manager/Care Coordinator	960000791	CA

General Provider Information

NPI Number	:	1144164104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISSE MARIE HERNANDEZ

Provider Business Mailing Address
First Line	:	3591 E IMPERIAL HWY
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2654
Country	:	US
Telephone Number	:	866-733-5924
Fax Number	:

Provider Business Practice Location Address
First Line	:	3591 E IMPERIAL HWY
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2654
Country	:	US
Telephone Number	:	866-733-5924
Fax Number	:

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

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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