Provider Demographics
NPI:1336455765
Name:HERNANDEZ, ISIS G (RD)
Entity Type:Individual
Prefix:MS
First Name:ISIS
Middle Name:G
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 E 88TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-1024
Mailing Address - Country:US
Mailing Address - Phone:323-490-4670
Mailing Address - Fax:
Practice Address - Street 1:726 E 88TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-1024
Practice Address - Country:US
Practice Address - Phone:323-490-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA996466133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered