Provider Demographics
NPI:1679616114
Name:HERNANDEZ, ROSA (NURSE)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 CROSBY ST
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-5473
Mailing Address - Country:US
Mailing Address - Phone:626-394-4610
Mailing Address - Fax:626-441-3814
Practice Address - Street 1:587 CROSBY ST
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-5473
Practice Address - Country:US
Practice Address - Phone:626-394-4610
Practice Address - Fax:626-441-3814
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223988164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse