Basic Information
| Provider Information | |||||||||
| NPI: | 1578758736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | CINTHYA | ||||||||
| MiddleName: | LILIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 737 W CHILDS AVE | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953416805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093831848 | ||||||||
| FaxNumber: | 2093831296 | ||||||||
| Practice Location | |||||||||
| Address1: | 637 MERCED ST | ||||||||
| Address2: | |||||||||
| City: | NEWMAN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953601070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098620270 | ||||||||
| FaxNumber: | 2098620274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 10/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95003754 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | ZZZ29799Z | 01 | CA | FQHC MEDICARE PART B | OTHER | 05-1063 | 01 | CA | FQHC MEDICARE PART A | OTHER |