Provider Demographics
NPI:1114400769
Name:HERNANDEZ ESCARENO, ADALI (MS RDN LDN)
Entity Type:Individual
Prefix:
First Name:ADALI
Middle Name:
Last Name:HERNANDEZ ESCARENO
Suffix:
Gender:F
Credentials:MS RDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6836 BUTTE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1006
Mailing Address - Country:US
Mailing Address - Phone:915-588-3634
Mailing Address - Fax:
Practice Address - Street 1:6836 BUTTE DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1006
Practice Address - Country:US
Practice Address - Phone:915-588-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
983239133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered