Healthcare Provider Details

I. General information

NPI: 1134067689
Provider Name (Legal Business Name): JONATHAN RAY HERNANDEZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 S BERENDO ST APT 315
LOS ANGELES CA
90005-1609
US

IV. Provider business mailing address

716 S BERENDO ST APT 315
LOS ANGELES CA
90005-1609
US

V. Phone/Fax

Practice location:
  • Phone: 512-773-6695
  • Fax:
Mailing address:
  • Phone: 512-773-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number37525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: