Healthcare Provider Details

I. General information

NPI: 1265358873
Provider Name (Legal Business Name): DAVID HERNANDEZ LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13300 GARDEN GROVE BLVD
GARDEN GROVE CA
92843-2207
US

IV. Provider business mailing address

837 HERBERT AVE
LOS ANGELES CA
90063-1737
US

V. Phone/Fax

Practice location:
  • Phone: 714-468-1100
  • Fax:
Mailing address:
  • Phone: 562-552-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number723133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: