Provider Demographics
NPI:1467679522
Name:HERNANDEZ, VALERIE C (PA)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:C
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11321
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-0321
Mailing Address - Country:US
Mailing Address - Phone:562-968-8452
Mailing Address - Fax:
Practice Address - Street 1:1401 W 1ST ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3757
Practice Address - Country:US
Practice Address - Phone:714-542-9700
Practice Address - Fax:714-542-9708
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18344Medicaid