Provider Demographics
NPI:1386022739
Name:HERNANDEZ, SILVIA ERIKA (RDA)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:ERIKA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 W 10TH ST APT M
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-4529
Mailing Address - Country:US
Mailing Address - Phone:626-755-1108
Mailing Address - Fax:
Practice Address - Street 1:1129 W 10TH ST APT M
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-4529
Practice Address - Country:US
Practice Address - Phone:626-755-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78818126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA78818OtherDENTAL BOARD OF CALIFORNIA