Healthcare Provider Details

I. General information

NPI: 1689342545
Provider Name (Legal Business Name): HECTOR DANIEL HERNANDEZ VILLALVAZO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17008 13TH STREET, HURON, CA 93234.
HURON CA
93234
US

IV. Provider business mailing address

17008 13TH STREET
HURON CA
93234
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone: 800-492-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number106741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: