Provider Demographics
NPI:1457864191
Name:HERNANDEZ, YESSICA KARINA
Entity Type:Individual
Prefix:MS
First Name:YESSICA
Middle Name:KARINA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YESSICA
Other - Middle Name:KARINA
Other - Last Name:JACOME MAGANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JESSICA MAGANA
Mailing Address - Street 1:1421 GUERNEVILLE RD STE 218
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7255
Mailing Address - Country:US
Mailing Address - Phone:707-576-7700
Mailing Address - Fax:707-576-7744
Practice Address - Street 1:1421 GUERNEVILLE RD STE 218
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-7255
Practice Address - Country:US
Practice Address - Phone:707-576-7700
Practice Address - Fax:707-576-7744
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist