Provider Demographics
NPI:1194399493
Name:HERNANDEZ, PATRICIA Y (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:Y
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HAIR LOSS SPECIALIST
Mailing Address - Street 1:3154 WINLOW ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-3725
Mailing Address - Country:US
Mailing Address - Phone:619-316-5028
Mailing Address - Fax:
Practice Address - Street 1:3154 WINLOW ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-3725
Practice Address - Country:US
Practice Address - Phone:619-316-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224P00000X, 332B00000X, 335E00000X
CAKK2753361744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier