Provider Demographics
NPI:1811162399
Name:HERNANDEZ, EDITH MARIN (LVN)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:MARIN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13614 ZIRCON WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-0563
Mailing Address - Country:US
Mailing Address - Phone:760-780-0717
Mailing Address - Fax:
Practice Address - Street 1:13614 ZIRCON WAY
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-0563
Practice Address - Country:US
Practice Address - Phone:760-780-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN218645164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse