Healthcare Provider Details

I. General information

NPI: 1275482036
Provider Name (Legal Business Name): MR. ALBERT HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W BELLEVUE DR STE 4
PASADENA CA
91105-2548
US

IV. Provider business mailing address

301 N LAKE AVE SUITE 600 PMB 301-3165
PASADENA CA
91101-4107
US

V. Phone/Fax

Practice location:
  • Phone: 626-219-2785
  • Fax:
Mailing address:
  • Phone: 626-219-2785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: