MEDICARE: PATRICIA Y HERNANDEZ HAIR LOSS SPECIALIST

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	224P00000X	Prosthetist
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	335E00000X	Prosthetic/Orthotic Supplier
4	1744P3200X	Prosthetics Case Management	KK275336	CA

General Provider Information

NPI Number	:	1194399493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA Y HERNANDEZ HAIR LOSS SPECIALIST

Provider Business Mailing Address
First Line	:	3154 WINLOW ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-3725
Country	:	US
Telephone Number	:	619-316-5028
Fax Number	:

Provider Business Practice Location Address
First Line	:	3154 WINLOW ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-3725
Country	:	US
Telephone Number	:	619-316-5028
Fax Number	:

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

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	01/23/2023

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