Provider Demographics
NPI:1790061729
Name:HERNANDEZ, CASSANDRA (BA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2764 COTTONWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7439
Mailing Address - Country:US
Mailing Address - Phone:909-724-8246
Mailing Address - Fax:
Practice Address - Street 1:1460 E HOLT AVE STE 8
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5835
Practice Address - Country:US
Practice Address - Phone:909-865-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner