Provider Demographics
NPI:1053814103
Name:HERNANDEZ, SANDY PAOLA
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:PAOLA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-5062
Mailing Address - Country:US
Mailing Address - Phone:562-548-6500
Mailing Address - Fax:
Practice Address - Street 1:CORTICA
Practice Address - Street 2:21515 HAWTHORNE BLVD STE GL-100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5062
Practice Address - Country:US
Practice Address - Phone:424-571-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator