Provider Demographics
NPI:1164435558
Name:HERNANDEZ, ANA MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:MARIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 GOODYEAR AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7749
Mailing Address - Country:US
Mailing Address - Phone:805-985-1159
Mailing Address - Fax:805-985-9344
Practice Address - Street 1:2100 GOODYEAR AVE STE 11
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7749
Practice Address - Country:US
Practice Address - Phone:805-985-1159
Practice Address - Fax:805-985-9344
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist