Provider Demographics
NPI:1891538187
Name:HERNANDEZ, SHARON JUSTINE DIZON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:JUSTINE DIZON
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12433 LAMBERT RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2770
Mailing Address - Country:US
Mailing Address - Phone:844-877-4648
Mailing Address - Fax:714-276-9611
Practice Address - Street 1:12433 LAMBERT RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2770
Practice Address - Country:US
Practice Address - Phone:626-824-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030103363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health