Provider Demographics
NPI:1962521906
Name:HERNANDEZ, ADRIANA RAE (MT)
Entity type:Individual
Prefix:MISS
First Name:ADRIANA
Middle Name:RAE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12431 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-3055
Mailing Address - Country:US
Mailing Address - Phone:562-881-4136
Mailing Address - Fax:
Practice Address - Street 1:1309 S EUCLID ST
Practice Address - Street 2:SUITE A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2078
Practice Address - Country:US
Practice Address - Phone:714-776-1197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor