Provider Demographics
NPI:1710272802
Name:HERNANDEZ, WINTER ANNA (LVN)
Entity Type:Individual
Prefix:
First Name:WINTER
Middle Name:ANNA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1637
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-1637
Mailing Address - Country:US
Mailing Address - Phone:909-969-1142
Mailing Address - Fax:
Practice Address - Street 1:11210 4TH ST
Practice Address - Street 2:3119
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6042
Practice Address - Country:US
Practice Address - Phone:909-969-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253172164X00000X
CA00773524376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide