Provider Demographics
NPI:1497283618
Name:HERNANDEZ, NYCHELE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:NYCHELE
Middle Name:ELIZABETH
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 1:11822 FLORAL DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-2900
Mailing Address - Country:US
Mailing Address - Phone:562-908-4355
Mailing Address - Fax:562-908-4363
Practice Address - Street 1:11822 FLORAL DR
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-2900
Practice Address - Country:US
Practice Address - Phone:562-908-4355
Practice Address - Fax:562-908-4363
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
WAPA61120247363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1143776OtherNCCPA