Provider Demographics
NPI:1295060135
Name:HERNANDEZ, MIREYA (DC)
Entity type:Individual
Prefix:DR
First Name:MIREYA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5836 BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1058
Mailing Address - Country:US
Mailing Address - Phone:562-461-3998
Mailing Address - Fax:562-920-3087
Practice Address - Street 1:5836 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1058
Practice Address - Country:US
Practice Address - Phone:562-461-3998
Practice Address - Fax:562-920-3087
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor