Provider Demographics
NPI:1700410891
Name:HERNANDEZ, ANDREA MICHELLE
Entity Type:Individual
Prefix:
First Name:ANDREA MICHELLE
Middle Name:
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 1:41429 STAFFORD CT
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-4020
Mailing Address - Country:US
Mailing Address - Phone:760-898-1185
Mailing Address - Fax:
Practice Address - Street 1:47875 CALEO BAY DR
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-6386
Practice Address - Country:US
Practice Address - Phone:760-771-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18775171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist