Provider Demographics
NPI:1750043998
Name:HERNANDEZ, COLLEEN ELAYNE (MS CHILD DEVELOPMENT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ELAYNE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS CHILD DEVELOPMENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8867 SPRINGHURST DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3214
Mailing Address - Country:US
Mailing Address - Phone:714-618-5513
Mailing Address - Fax:
Practice Address - Street 1:5301 ELMER WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-2414
Practice Address - Country:US
Practice Address - Phone:916-395-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program