1427233345 NPI number — FEDERICO R HERNANDEZ DPM A PROFESSIONAL CORP

Table of content: (NPI 1427233345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427233345 NPI number — FEDERICO R HERNANDEZ DPM A PROFESSIONAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FEDERICO R HERNANDEZ DPM A PROFESSIONAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1427233345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 318
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL CENTRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92244-0318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-352-6062
Provider Business Mailing Address Fax Number:
760-332-0400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1665 S IMPERIAL AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-4253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-352-6062
Provider Business Practice Location Address Fax Number:
760-332-0400
Provider Enumeration Date:
01/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
FEDERICO
Authorized Official Middle Name:
RENE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
760-352-6062

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  E1187 , 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: 1801930318 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 000E11871 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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