Provider Demographics
NPI:1225788813
Name:HERNANDEZ, VICKY YVETTE JR
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:YVETTE
Last Name:HERNANDEZ
Suffix:JR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 HARTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6899
Mailing Address - Country:US
Mailing Address - Phone:909-276-9836
Mailing Address - Fax:
Practice Address - Street 1:1668 HARTLEY AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-6899
Practice Address - Country:US
Practice Address - Phone:909-276-9836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV00002910807Medicaid