Provider Demographics
NPI:1649596255
Name:HERNANDEZ, JULIA GRISELDA (CA LM 142, IBCLC)
Entity Type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:GRISELDA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CA LM 142, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1914
Mailing Address - Country:US
Mailing Address - Phone:415-307-7251
Mailing Address - Fax:415-453-8223
Practice Address - Street 1:15 VALLEY RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1914
Practice Address - Country:US
Practice Address - Phone:415-307-7251
Practice Address - Fax:415-453-8223
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA LM 142176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife