Provider Demographics
NPI:1083844260
Name:HERNANDEZ, ROXANA MELISSA (RD)
Entity Type:Individual
Prefix:MS
First Name:ROXANA
Middle Name:MELISSA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 WOODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6409
Mailing Address - Country:US
Mailing Address - Phone:818-590-3563
Mailing Address - Fax:
Practice Address - Street 1:4502 E AVENUE S
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4480
Practice Address - Country:US
Practice Address - Phone:661-533-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1024574133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered