Provider Demographics
NPI:1508511452
Name:HERNANDEZ, AMANDA PRISCILLA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:PRISCILLA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-2432
Mailing Address - Country:US
Mailing Address - Phone:161-977-9424
Mailing Address - Fax:
Practice Address - Street 1:720 N VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-2432
Practice Address - Country:US
Practice Address - Phone:619-779-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant