Healthcare Provider Details

I. General information

NPI: 1912417007
Provider Name (Legal Business Name): DAVID J. HERNANDEZ MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2017
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: 747-265-6424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID JACINTO HERNANDEZ
Title or Position: DIRECTOR
Credential: MD
Phone: 818-403-8728