Provider Demographics
NPI:1205341393
Name:HERNANDEZ, DIANA MARITZA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARITZA
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 1:7861 WINNETKA AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2350
Mailing Address - Country:US
Mailing Address - Phone:818-271-0754
Mailing Address - Fax:
Practice Address - Street 1:6957 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042
Practice Address - Country:US
Practice Address - Phone:323-443-3175
Practice Address - Fax:323-443-3270
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner