MEDICARE: ERICA 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	2355S0801X	Speech-Language Assistant		CA

General Provider Information

NPI Number	:	1811577018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA HERNANDEZ

Provider Business Mailing Address
First Line	:	17216 SATICOY ST # 141
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-2103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 S GLENDORA AVE
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-4924
Country	:	US
Telephone Number	:	626-739-3638
Fax Number	:

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

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	04/12/2021

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Directions to “ ERICA HERNANDEZ ” Practice Location

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