Healthcare Provider Details

I. General information

NPI: 1992040802
Provider Name (Legal Business Name): MS. ALBERTO A. HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 E EL SEGUNDO BLVD
COMPTON CA
90222-7109
US

IV. Provider business mailing address

2610 INDUSTRY WAY
LYNWOOD CA
90262-4283
US

V. Phone/Fax

Practice location:
  • Phone: 310-637-0917
  • Fax: 310-637-0473
Mailing address:
  • Phone: 310-631-8004
  • Fax: 310-631-7830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: