Provider Demographics
NPI:1265746929
Name:HERNANDEZ, ROSA NELLTY (MSOD)
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:NELLTY
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MSOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712
Mailing Address - Country:US
Mailing Address - Phone:562-420-4787
Mailing Address - Fax:
Practice Address - Street 1:4365 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-3767
Practice Address - Country:US
Practice Address - Phone:562-208-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist