Individual
KIM ELAINE HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
18655 W BERNARDO DR, SAN DIEGO, CA 92127-3002
(858) 579-1859
Mailing address
18216 MIRASOL DR, SAN DIEGO, CA 92128-1226
(858) 864-2204
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT2323
CA
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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