Healthcare Provider Details

I. General information

NPI: 1396756912
Provider Name (Legal Business Name): DAVID J HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7012 RESEDA BLVD STE 100
RESEDA CA
91335-4219
US

IV. Provider business mailing address

7012 RESEDA BLVD STE 100
RESEDA CA
91335-4219
US

V. Phone/Fax

Practice location:
  • Phone: 747-265-6423
  • Fax: 747-265-6424
Mailing address:
  • Phone: 747-265-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG48343
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG48343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: