Healthcare Provider Details

I. General information

NPI: 1205434529
Provider Name (Legal Business Name): EDWAR HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1556 S SULTANA AVE
ONTARIO CA
91761-4238
US

IV. Provider business mailing address

445 W 10TH ST
POMONA CA
91766-3116
US

V. Phone/Fax

Practice location:
  • Phone: 909-418-6923
  • Fax:
Mailing address:
  • Phone: 909-202-5914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: