1497018220 NPI number — LAUREN E HERNANDEZ PA-C

Table of content: LAUREN E HERNANDEZ PA-C (NPI 1497018220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497018220 NPI number — LAUREN E HERNANDEZ PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
LAUREN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1497018220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 EAST CENTER AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93291-6331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-737-4700
Provider Business Mailing Address Fax Number:
559-737-4782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41651 SIERRA DRIVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
THREE RIVERS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93271-9678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-561-4683
Provider Business Practice Location Address Fax Number:
559-561-4326
Provider Enumeration Date:
06/18/2012

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: 363AM0700X , with the licence number:  PA 22332 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA22332 , 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)

  • Identifier: PA 22332 . This is a "LICENST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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