Healthcare Provider Details

I. General information

NPI: 1598886038
Provider Name (Legal Business Name): LILIA G HERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. LILIA HERNANDEZ MORTERA

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 BEVILACQUA CT
PLEASANTON CA
94566-7104
US

IV. Provider business mailing address

4341 BEVILACQUA CT
PLEASANTON CA
94566-7104
US

V. Phone/Fax

Practice location:
  • Phone: 925-918-1738
  • Fax: 925-417-8811
Mailing address:
  • Phone: 925-918-1738
  • Fax: 925-417-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA39635
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number146054
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: