MEDICARE: MISS ADRIANA RAE HERNANDEZ M.T.

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	111N00000X	Chiropractor	PENDING	CA

General Provider Information

NPI Number	:	1962521906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ADRIANA RAE HERNANDEZ M.T.

Provider Business Mailing Address
First Line	:	12431 ROSE DR
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-3055
Country	:	US
Telephone Number	:	562-881-4136
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 S EUCLID ST
Second Line	:	SUITE A
City	:	ANAHEIM
State	:	CA
Zip	:	92802-2078
Country	:	US
Telephone Number	:	714-776-1197
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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