Provider Demographics
NPI:1447721147
Name:HERNANDEZ RENDON, AMANDA LEIGH (RCP RRT-NPS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:HERNANDEZ RENDON
Suffix:
Gender:F
Credentials:RCP RRT-NPS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEIGH HERNANDEZ
Other - Last Name:RENDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1600 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-784-5427
Mailing Address - Fax:
Practice Address - Street 1:1600 EUREKA RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3027
Practice Address - Country:US
Practice Address - Phone:916-784-5427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291462279P3900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
111965OtherNATIONAL BOARD OF RESPIRATORY CARE RRT-NPS
CA29146OtherSTATE RESPIRATORY CARE PRACTITIONER LICENSE