Provider Demographics
NPI:1629665518
Name:HENDRIX, ILIANA BEATRIX (CST)
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:BEATRIX
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:ILIANA
Other - Middle Name:BEATRIZ
Other - Last Name:ORTIZ-MENJIVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22726 MADRID DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4625
Mailing Address - Country:US
Mailing Address - Phone:949-434-9044
Mailing Address - Fax:
Practice Address - Street 1:22726 MADRID DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4625
Practice Address - Country:US
Practice Address - Phone:949-434-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-24
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No374700000XNursing Service Related ProvidersTechnician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide