Provider Demographics
NPI:1780275040
Name:HERNANDEZ, MARLENE ELIZABETH
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:ELIZABETH
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 1:6001 CLARA ST
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4723
Mailing Address - Country:US
Mailing Address - Phone:562-806-5000
Mailing Address - Fax:
Practice Address - Street 1:6001 CLARA ST
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-4723
Practice Address - Country:US
Practice Address - Phone:562-806-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner