1083749337 NPI number — MRS. LIZBETH GUADALUPE HERNANDEZ MFTI

Table of content: MRS. LIZBETH GUADALUPE HERNANDEZ MFTI (NPI 1083749337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083749337 NPI number — MRS. LIZBETH GUADALUPE HERNANDEZ MFTI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
LIZBETH
Provider Middle Name:
GUADALUPE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFTI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVERA
Provider Other First Name:
LIZBETH
Provider Other Middle Name:
GUADALUPE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083749337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
813 W WHITTIER BLVD
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
MONTEBELLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90640-4759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-991-9876
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
813 W WHITTIER BLVD
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
MONTEBELLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90640-4759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-991-9876
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  83508 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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