Provider Demographics
NPI:1780395491
Name:HERNANDEZ, KATHRYN ALYSSA (RN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ALYSSA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HIGHLAND HOSPITAL, OMFS
Mailing Address - Street 2:1411 EAST 31ST STREET
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602
Mailing Address - Country:US
Mailing Address - Phone:510-437-5050
Mailing Address - Fax:
Practice Address - Street 1:HIGHLAND HOSPITAL, OMFS
Practice Address - Street 2:1411 EAST 31ST STREET
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602
Practice Address - Country:US
Practice Address - Phone:510-437-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA846857163WP2201X
CA5459722083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine