Provider Demographics
NPI:1346586864
Name:HERNANDEZ, IRENE
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:HERNANDEZ
Suffix:
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 1:14525 LAKEWOOD BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-3638
Mailing Address - Country:US
Mailing Address - Phone:562-272-0000
Mailing Address - Fax:
Practice Address - Street 1:14525 LAKEWOOD BLVD STE A
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-3638
Practice Address - Country:US
Practice Address - Phone:562-272-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant