Healthcare Provider Details

I. General information

NPI: 1932703642
Provider Name (Legal Business Name): RODRIGO HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 E VICTORIA ST
COMPTON CA
90221-5617
US

IV. Provider business mailing address

5715 S BROADWAY
LOS ANGELES CA
90037-4131
US

V. Phone/Fax

Practice location:
  • Phone: 424-403-5800
  • Fax: 424-403-5802
Mailing address:
  • Phone: 323-948-0444
  • Fax: 323-948-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: