Provider Demographics
NPI:1093527400
Name:HERNANDEZ, ROSALINA ANGELICA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ROSALINA
Middle Name:ANGELICA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11059 EATON WAY
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-2921
Mailing Address - Country:US
Mailing Address - Phone:323-803-8783
Mailing Address - Fax:
Practice Address - Street 1:11059 EATON WAY
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-2921
Practice Address - Country:US
Practice Address - Phone:323-803-8783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95202303163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant