Provider Demographics
NPI:1811461155
Name:HERNANDEZ, ELAINE CERENO (FNP, RN)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:CERENO
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 WILSHIRE BLVD STE 334
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3611
Mailing Address - Country:US
Mailing Address - Phone:323-935-5200
Mailing Address - Fax:
Practice Address - Street 1:4201 WILSHIRE BLVD STE 334
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3611
Practice Address - Country:US
Practice Address - Phone:323-935-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010178363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner