Provider Demographics
NPI:1467798074
Name:HERNANDEZ, DEBRA (RDA)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
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 1:14349 GRAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4949
Mailing Address - Country:US
Mailing Address - Phone:562-519-1637
Mailing Address - Fax:
Practice Address - Street 1:8381 LA PALMA AVE
Practice Address - Street 2:SUITE B&C
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3271
Practice Address - Country:US
Practice Address - Phone:714-228-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72278126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant