Provider Demographics
NPI:1952547564
Name:HERNANDEZ, GRACIELA (NP)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N BRENT ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2817
Mailing Address - Country:US
Mailing Address - Phone:805-667-3909
Mailing Address - Fax:805-667-3915
Practice Address - Street 1:168 N BRENT ST
Practice Address - Street 2:SUITE 405
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2817
Practice Address - Country:US
Practice Address - Phone:805-667-3909
Practice Address - Fax:805-667-3915
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18586163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse