Healthcare Provider Details

I. General information

NPI: 1316105505
Provider Name (Legal Business Name): DAVID HERNANDEZ-RODRIGUEZ MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2008
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 EAST HOLT STREET
ONTARIO CA
91761-1704
US

IV. Provider business mailing address

517 E. HOLT STREET
ONTARIO CA
91761-1704
US

V. Phone/Fax

Practice location:
  • Phone: 909-933-2818
  • Fax: 909-391-1401
Mailing address:
  • Phone: 909-933-2818
  • Fax: 909-391-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA102591
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA102591
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID HERNANDEZ-RODRIGUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-956-2131