Healthcare Provider Details

I. General information

NPI: 1932916079
Provider Name (Legal Business Name): PAUL MICHAEL HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N JOHNSON AVE STE 101
EL CAJON CA
92020-1651
US

IV. Provider business mailing address

1400 N JOHNSON AVE STE 101
EL CAJON CA
92020-1651
US

V. Phone/Fax

Practice location:
  • Phone: 619-442-0277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number19665
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number19665
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number19665
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number19665
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number19665
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number19665
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code226000000X
TaxonomyRecreational Therapist Assistant
License Number19665
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number19665
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number19665
License Number StateCA
# 10
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: