MEDICARE: DIANNA 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	363LA2200X	Adult Health Nurse Practitioner	95037219	CA
2	363LG0600X	Gerontology Nurse Practitioner	95037219	CA
3	363L00000X	Nurse Practitioner	95037219	CA

General Provider Information

NPI Number	:	1720951593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNA HERNANDEZ

Provider Business Mailing Address
First Line	:	99 BUSINESS PARK DR
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92571-3165
Country	:	US
Telephone Number	:	951-956-2131
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 BUSINESS PARK DR
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92571-3165
Country	:	US
Telephone Number	:	951-956-2131
Fax Number	:

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

Provider Enumeration Date	:	09/26/2025
Last Update Date	:	09/26/2025

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Directions to “ DIANNA HERNANDEZ ” Practice Location

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