Provider Demographics
NPI:1376570978
Name:HERNANDEZ, CHERISSE MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:CHERISSE
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 E LINCOLN AVE
Mailing Address - Street 2:APT 223
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4043
Mailing Address - Country:US
Mailing Address - Phone:714-666-8299
Mailing Address - Fax:
Practice Address - Street 1:520 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5559
Practice Address - Country:US
Practice Address - Phone:909-910-9157
Practice Address - Fax:714-567-4952
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer