1255647236 NPI number — MRS. ADELA LISSETTE HERNANDEZ RODARTE

Table of content: MRS. ADELA LISSETTE HERNANDEZ RODARTE (NPI 1255647236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255647236 NPI number — MRS. ADELA LISSETTE HERNANDEZ RODARTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ RODARTE
Provider First Name:
ADELA
Provider Middle Name:
LISSETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255647236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 EAST 12TH STREET SUITE 259
Provider Second Line Business Mailing Address:
WESTCOAST CHILDRENS CLINIC
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-269-9030
Provider Business Mailing Address Fax Number:
510-269-9031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 EAST 12TH STREET SUITE 259
Provider Second Line Business Practice Location Address:
WESTCOAST CHILDRENS CLINIC
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-269-9030
Provider Business Practice Location Address Fax Number:
510-269-9031
Provider Enumeration Date:
08/27/2010

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: 101Y00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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