Provider Demographics
NPI:1780561415
Name:HERNANDEZ, STEFFEN ENRIQUE
Entity type:Individual
Prefix:
First Name:STEFFEN
Middle Name:ENRIQUE
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 E SCHOOL WAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-6320
Mailing Address - Country:US
Mailing Address - Phone:707-472-8775
Mailing Address - Fax:
Practice Address - Street 1:310 1/2 1ST ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-6036
Practice Address - Country:US
Practice Address - Phone:530-763-5918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X
CAE208896146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No372600000XNursing Service Related ProvidersAdult Companion