Provider Demographics
NPI:1699903658
Name:HERNANDEZ, ROBIN MICHELE (OTA/L)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:MICHELE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41350 SHADOW MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-8291
Mailing Address - Country:US
Mailing Address - Phone:951-765-0126
Mailing Address - Fax:
Practice Address - Street 1:275 N SAN JACINTO ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4453
Practice Address - Country:US
Practice Address - Phone:951-658-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA662224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant