Individual
ILIANA BEATRIX HENDRIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
22726 MADRID DR, LAKE FOREST, CA 92630-4625
(949) 434-9044
Mailing address
22726 MADRID DR, LAKE FOREST, CA 92630-4625
(949) 434-9044
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
—
374700000X
Technician
—
—
3747P1801X
Personal Care Attendant
—
—
376K00000X
Nurse's Aide
—
—
Other
Enumeration date
12/24/2020
Last updated
06/10/2021
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