MEDICARE: SHARON JUSTINE DIZON 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95030103	CA

General Provider Information

NPI Number	:	1891538187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON JUSTINE DIZON HERNANDEZ

Provider Business Mailing Address
First Line	:	12433 LAMBERT RD
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-2770
Country	:	US
Telephone Number	:	844-877-4648
Fax Number	:	714-276-9611

Provider Business Practice Location Address
First Line	:	12433 LAMBERT RD
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-2770
Country	:	US
Telephone Number	:	626-824-0289
Fax Number	:

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

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	06/14/2024

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