Provider Demographics
NPI:1497018220
Name:HERNANDEZ, LAUREN E (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 EAST CENTER AVE.
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6331
Mailing Address - Country:US
Mailing Address - Phone:559-737-4700
Mailing Address - Fax:559-737-4782
Practice Address - Street 1:41651 SIERRA DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:THREE RIVERS
Practice Address - State:CA
Practice Address - Zip Code:93271-9678
Practice Address - Country:US
Practice Address - Phone:559-561-4683
Practice Address - Fax:559-561-4326
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 22332363AM0700X
CAPA22332363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 22332OtherLICENST