MEDICARE: MIGUEL HERNANDEZ GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	191370	CA

General Provider Information

NPI Number	:	1528919289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL HERNANDEZ GONZALEZ

Provider Business Mailing Address
First Line	:	IDS PHARMACY 200 MEDICAL PLAZA ROOM 130
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-0001
Country	:	US
Telephone Number	:	310-267-1561
Fax Number	:

Provider Business Practice Location Address
First Line	:	IDS PHARMACY 200 MEDICAL PLAZA ROOM 130
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-0001
Country	:	US
Telephone Number	:	310-267-1561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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