Provider Demographics
NPI:1003930918
Name:HERNANDEZ, CONNIE SUTHERLAND (ND)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:SUTHERLAND
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4153 EL CAMINO WAY STE B
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-4034
Mailing Address - Country:US
Mailing Address - Phone:650-857-0226
Mailing Address - Fax:650-857-0264
Practice Address - Street 1:4153 EL CAMINO WAY STE B
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-4034
Practice Address - Country:US
Practice Address - Phone:650-857-0226
Practice Address - Fax:650-857-0264
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-62175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath