Provider Demographics
NPI:1609616663
Name:HERNANDEZ, AMERICA CITLALLI
Entity type:Individual
Prefix:
First Name:AMERICA
Middle Name:CITLALLI
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMERICA
Other - Middle Name:CITLALLI
Other - Last Name:CARRILLO NAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10801 6TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5987
Mailing Address - Country:US
Mailing Address - Phone:909-637-6794
Mailing Address - Fax:
Practice Address - Street 1:10801 6TH ST STE 120
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5987
Practice Address - Country:US
Practice Address - Phone:909-637-6794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker