Healthcare Provider Details

I. General information

NPI: 1225659006
Provider Name (Legal Business Name): THOMAS HERNANDEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 S MCDOWELL BLVD
PETALUMA CA
94954-3507
US

IV. Provider business mailing address

335 S MCDOWELL BLVD
PETALUMA CA
94954-3507
US

V. Phone/Fax

Practice location:
  • Phone: 415-927-0666
  • Fax: 415-927-6159
Mailing address:
  • Phone: 415-927-0666
  • Fax: 415-927-6159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: