Provider Demographics
NPI:1912694118
Name:HERNANDEZ, DAHLIA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:DAHLIA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 SEASONS RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3558
Mailing Address - Country:US
Mailing Address - Phone:707-495-5998
Mailing Address - Fax:
Practice Address - Street 1:27700 MEDICAL CENTER RD FL 5
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6426
Practice Address - Country:US
Practice Address - Phone:949-347-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22698OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY
459025OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY