Provider Demographics
NPI:1114016433
Name:ARTEAGA-HERNANDEZ, EDNA SONIA (MD)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:SONIA
Last Name:ARTEAGA-HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4700
Mailing Address - Country:US
Mailing Address - Phone:909-873-3876
Mailing Address - Fax:909-873-3875
Practice Address - Street 1:851 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4700
Practice Address - Country:US
Practice Address - Phone:909-873-3876
Practice Address - Fax:909-873-3875
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A636270Medicaid
CA00A636270Medicaid