1023168754 NPI number — DR. ROGELIO PEREZ HERNANDEZ DMD

Table of content: DR. ROGELIO PEREZ HERNANDEZ DMD (NPI 1023168754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023168754 NPI number — DR. ROGELIO PEREZ HERNANDEZ DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
ROGELIO
Provider Middle Name:
PEREZ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023168754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 W 7TH ST
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
HANFORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-582-4349
Provider Business Mailing Address Fax Number:
559-582-8064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 W 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 104 HANFORD FAMILY DENTAL
Provider Business Practice Location Address City Name:
HANFORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-582-4349
Provider Business Practice Location Address Fax Number:
559-582-8064
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  26180 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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