Provider Demographics
NPI:1750897542
Name:HERNANDEZ, ESMERALDA LOPEZ
Entity type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:LOPEZ
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N TUSTIN AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3606
Mailing Address - Country:US
Mailing Address - Phone:949-825-7650
Mailing Address - Fax:
Practice Address - Street 1:720 N TUSTIN AVE STE 104
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3606
Practice Address - Country:US
Practice Address - Phone:949-825-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-16
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA957499363LF0000X
CA95007499363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily