Provider Demographics
NPI:1154505642
Name:HERNANDEZ, MELISSA A (RD, CDE)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14309 KILLION ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-5109
Mailing Address - Country:US
Mailing Address - Phone:323-333-5157
Mailing Address - Fax:
Practice Address - Street 1:15301 RINALDI STREET
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91346
Practice Address - Country:US
Practice Address - Phone:818-496-4310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
954511133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered