Healthcare Provider Details

I. General information

NPI: 1811078421
Provider Name (Legal Business Name): WILFREDO HERNANDEZ-LINARES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WILFREDO HERNANDEZ MD

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S ALVARADO SUITE 815
LOS ANGELES CA
90057
US

IV. Provider business mailing address

PO BOX 67779
LOS ANGELES CA
90067
US

V. Phone/Fax

Practice location:
  • Phone: 223-481-0440
  • Fax:
Mailing address:
  • Phone: 310-273-7365
  • Fax: 310-273-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA26402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: