Provider Demographics
NPI:1679324727
Name:HERNANDEZ, ILANA SAMARA (CPC)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:SAMARA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 NE VANCOUVER MALL DR APT H78
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-7950
Mailing Address - Country:US
Mailing Address - Phone:509-851-4419
Mailing Address - Fax:
Practice Address - Street 1:5197 NW LOWER RIVER RD BLDG 1
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-1013
Practice Address - Country:US
Practice Address - Phone:360-205-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61511375175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist