Provider Demographics
NPI:1952121774
Name:HERNANDEZ-GAONA, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HERNANDEZ-GAONA
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 1:2711 10TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-4964
Mailing Address - Country:US
Mailing Address - Phone:951-335-2032
Mailing Address - Fax:
Practice Address - Street 1:2711 10TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-4964
Practice Address - Country:US
Practice Address - Phone:951-335-2032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2025-08-01
Deactivation Date:2025-01-16
Deactivation Code:
Reactivation Date:2025-08-01
Provider Licenses
StateLicense IDTaxonomies
CA01204804374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide