Individual
MA DOLORES HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 S HALE AVE SPC 54, ESCONDIDO, CA 92029-2177
(760) 729-8295
Mailing address
13549 ELSWORTH ST, MORENO VALLEY, CA 92553-8463
(951) 229-1129
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D5689720
DRIVER LICENSE
CA
Enumeration date
08/25/2020
Last updated
08/25/2020
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