Healthcare Provider Details

I. General information

NPI: 1396623971
Provider Name (Legal Business Name): DOMINIQUE HERNANDEZ AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 S ROBERTSON BLVD
BEVERLY HILLS CA
90211-3641
US

IV. Provider business mailing address

437 S ROBERTSON BLVD
BEVERLY HILLS CA
90211-3641
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-2148
  • Fax: 310-274-4431
Mailing address:
  • Phone: 310-274-2148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU4026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: