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NPI Code Detail

MEDICARE: MARILY HERNANDEZ RN

MEDICARE: MARILY HERNANDEZ RN
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
1171M00000XCase Manager/Care Coordinator95113076CA

General Provider Information

NPI Number : 1770479511
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILY HERNANDEZ RN
Provider Business Mailing Address
First Line : 5425 POMONA BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90022-1716
Country : US
Telephone Number : 323-728-0411
Fax Number :
Provider Business Practice Location Address
First Line : 3310 W CENTURY BLVD
Second Line :
City : INGLEWOOD
State : CA
Zip : 90303-1305
Country : US
Telephone Number : 323-765-6165
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2025
Last Update Date : 06/17/2025

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