Healthcare Provider Details

I. General information

NPI: 1134089600
Provider Name (Legal Business Name): OSCAR ANDRES HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

IV. Provider business mailing address

4860 AMMOLITE WAY
ELK GROVE CA
95757-1721
US

V. Phone/Fax

Practice location:
  • Phone: 916-688-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95366552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: