Healthcare Provider Details

I. General information

NPI: 1912936766
Provider Name (Legal Business Name): HERMANSON MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CANAL STREET
KING CITY CA
93930-3431
US

IV. Provider business mailing address

PO BOX 11300
WESTMINSTER CA
92685-1300
US

V. Phone/Fax

Practice location:
  • Phone: 831-385-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER G HERMANSON
Title or Position: PRESIDENT
Credential: MD
Phone: 831-385-6000