Provider Demographics
NPI:1124286018
Name:HERMOGENO, CONNIE (FNP)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HERMOGENO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CESAR CHAVEZ SUITE 354
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-221-5366
Mailing Address - Fax:323-221-5473
Practice Address - Street 1:1701 CESAR CHAVEZ SUITE 354
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-221-5366
Practice Address - Fax:323-221-5473
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily