1396756912 NPI number — DR. DAVID J HERNANDEZ MD

Table of content: DR. DAVID J HERNANDEZ MD (NPI 1396756912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396756912 NPI number — DR. DAVID J HERNANDEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
DAVID
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1396756912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7012 RESEDA BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RESEDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91335-4219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
747-265-6423
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7012 RESEDA BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91335-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-265-6423
Provider Business Practice Location Address Fax Number:
747-265-6424
Provider Enumeration Date:
08/10/2006

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: 207QA0505X , with the licence number:  G48343 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: G48343 , 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)

  • Identifier: HAP70769F . This is a "PROG GRP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC70769F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00275711 . This is a "MEDICARE RAILROAD #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BCP70769F . This is a "CDC PROGRAM GRP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: EAP70468F . This is a "PROGRAM GRP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com