Healthcare Provider Details

I. General information

NPI: 1538383880
Provider Name (Legal Business Name): JONATHAN SANTOS HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 CLAREMONT WAY
NAPA CA
94558-3313
US

IV. Provider business mailing address

3663 SOLANO AVE #120
NAPA CA
94558-2767
US

V. Phone/Fax

Practice location:
  • Phone: 707-258-2500
  • Fax:
Mailing address:
  • Phone: 707-294-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA99548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: