Rudy John Hernandez Jr.
Individual provider Active NPI Adult Psychiatric/Mental Health Registered Nurse · Crestline, CA
NPI 1124876800 · NPPES record last updated May 8, 2024
Key facts
- NPI
- 1124876800
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Psychiatric/Mental Health Registered Nurse 163WP0809X
- License
- 95044697 (CA)
- Practice address
- PO Box 1382
Crestline, CA 92325-1382 - Phone
- (951) 544-0200
- NPI assigned
- May 8, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95044697 | CA | MD | Adult Psychiatric/Mental Health Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Psychiatric/Mental Health Registered Nurse | 163WP0809X | 95044697 | CA | Yes |
Addresses
Primary practice location
PO Box 1382
Crestline, CA 92325-1382
Mailing address
PO Box 1382
Crestline, CA 92325-1382
Phone (951) 544-0200
Other providers in Crestline, CA
- Chelsea L Guest
- Angela Marguerite Harrington
- Monica Harrison
- Hearts & Lives
- Genova Isamar Hernandez Lizardo
- Olga Lucia Holguin
- Nanette A Howard
- Nicole Huffman
- Gwenda Ann Humpherys
- Misty Rhiannon Hutton
All providers in Crestline, CA · Adult Psychiatric/Mental Health Registered Nurse in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.