Provider Demographics
NPI:1598585895
Name:RODRIGUEZ HERNANDEZ, JESSICA E (CERTIFIED NURSING AS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:RODRIGUEZ HERNANDEZ
Suffix:
Gender:F
Credentials:CERTIFIED NURSING AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13582 MONTAGUE ST
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-5623
Mailing Address - Country:US
Mailing Address - Phone:818-251-0243
Mailing Address - Fax:
Practice Address - Street 1:13582 MONTAGUE ST
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-5623
Practice Address - Country:US
Practice Address - Phone:818-224-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00676527376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide