Provider Demographics
NPI:1407579113
Name:HERNANDEZ, LUDYVINA (DOCTORAL CANDIDATE)
Entity type:Individual
Prefix:
First Name:LUDYVINA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DOCTORAL CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8101
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-8101
Mailing Address - Country:US
Mailing Address - Phone:805-547-7900
Mailing Address - Fax:
Practice Address - Street 1:2400 E KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5945
Practice Address - Country:US
Practice Address - Phone:714-922-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program