Healthcare Provider Details

I. General information

NPI: 1851493688
Provider Name (Legal Business Name): CECILIA M HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE RM 5505
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-4444
  • Fax: 510-649-8287
Mailing address:
  • Phone: 510-204-1893
  • Fax: 510-649-8287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG77974
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberG77974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: