Provider Demographics
NPI:1518611383
Name:HERNANDEZ, ITZAYANA JOCELYN
Entity Type:Individual
Prefix:
First Name:ITZAYANA
Middle Name:JOCELYN
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 1:1393 MCGINNESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-4530
Mailing Address - Country:US
Mailing Address - Phone:498-439-2251
Mailing Address - Fax:
Practice Address - Street 1:1393 MCGINNESS AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-4530
Practice Address - Country:US
Practice Address - Phone:498-439-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator