Provider Demographics
NPI:1972732451
Name:HERNANDEZ, JENNY
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N GREEN VALLEY PKWY
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6391
Mailing Address - Country:US
Mailing Address - Phone:702-990-4530
Mailing Address - Fax:702-990-4527
Practice Address - Street 1:100 N GREEN VALLEY PKWY
Practice Address - Street 2:SUITE 340
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6391
Practice Address - Country:US
Practice Address - Phone:702-990-4530
Practice Address - Fax:702-990-4527
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist