MEDICARE: CHRISTIAN ULYSSES HERNANDEZ

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1992691687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN ULYSSES HERNANDEZ

Provider Business Mailing Address
First Line	:	9450 GILMAN DR # 60119
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92092-0102
Country	:	US
Telephone Number	:	619-728-5065
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 W BROADWAY STE 1540
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-3770
Country	:	US
Telephone Number	:	619-728-5065
Fax Number	:

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

Provider Enumeration Date	:	06/17/2025
Last Update Date	:	06/18/2025

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