MEDICARE: VANESSA HERNANDEZ MD

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	2084P0800X	Psychiatry Physician	A92855	CA

General Provider Information

NPI Number	:	1891836425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA HERNANDEZ MD

Provider Business Mailing Address
First Line	:	1601 N SEPULVEDA BLVD STE 117
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5111
Country	:	US
Telephone Number	:	310-285-8530
Fax Number	:	800-677-6430

Provider Business Practice Location Address
First Line	:	3201 N SEPULVEDA BLVD STE H
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2463
Country	:	US
Telephone Number	:	310-285-8530
Fax Number	:	800-677-6430

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/21/2022

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