Provider Demographics
NPI:1760172696
Name:HERNANDEZ-BALL, ELIZABETH MARIA ELENA (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIA ELENA
Last Name:HERNANDEZ-BALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ESPLANADE UNIT 36
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4147
Mailing Address - Country:US
Mailing Address - Phone:310-318-4127
Mailing Address - Fax:
Practice Address - Street 1:5001 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5441
Practice Address - Country:US
Practice Address - Phone:310-318-4127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024994363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care