Healthcare Provider Details

I. General information

NPI: 1063690659
Provider Name (Legal Business Name): ISRAEL J HERNANDEZ-ARCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21501 AVALON BLVD STE 100
CARSON CA
90745-2210
US

IV. Provider business mailing address

21501 AVALON BLVD STE 100
CARSON CA
90745-2210
US

V. Phone/Fax

Practice location:
  • Phone: 310-835-6627
  • Fax: 310-835-9830
Mailing address:
  • Phone: 310-835-6627
  • Fax: 310-835-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA102534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: