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Individual

STACY D HERNANDEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
17542 17TH ST STE 300, TUSTIN, CA 92780-1960
(714) 734-4500
Mailing address
988 S CITRON ST, ANAHEIM, CA 92805-5575
(562) 805-7293

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
49723
CA

Other

Enumeration date
10/08/2024
Last updated
10/08/2024
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