Provider Demographics
NPI:1427065267
Name:HERNANDEZ, SYLVIA ANN (RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:ANN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 E ATHERTON ST STE 416
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4023
Mailing Address - Country:US
Mailing Address - Phone:629-880-0405
Mailing Address - Fax:562-988-0041
Practice Address - Street 1:5500 E ATHERTON ST STE 416
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4023
Practice Address - Country:US
Practice Address - Phone:562-988-0040
Practice Address - Fax:562-988-0041
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA707964133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMNT707964Medicare UPIN