Provider Demographics
NPI:1770018897
Name:HERNANDEZ, CAROLINA (BACHELOR'S DEGREE)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:BACHELOR'S DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40005 10TH ST W STE 106
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3037
Mailing Address - Country:US
Mailing Address - Phone:661-265-8627
Mailing Address - Fax:661-265-7936
Practice Address - Street 1:40005 10TH ST W STE 106
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3037
Practice Address - Country:US
Practice Address - Phone:661-265-8627
Practice Address - Fax:661-265-7936
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner