Provider Demographics
NPI:1447742374
Name:HERNANDEZ, TARYN RACHELLE
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:RACHELLE
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 1:1020 IOWA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2105
Mailing Address - Country:US
Mailing Address - Phone:951-358-7500
Mailing Address - Fax:951-358-7606
Practice Address - Street 1:1020 IOWA AVE STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2105
Practice Address - Country:US
Practice Address - Phone:951-358-7500
Practice Address - Fax:951-358-7606
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator