Healthcare Provider Details

I. General information

NPI: 1639008519
Provider Name (Legal Business Name): JESSICA E HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 SPARLING ST
SAN DIEGO CA
92115-6905
US

IV. Provider business mailing address

3536 SPARLING ST
SAN DIEGO CA
92115-6905
US

V. Phone/Fax

Practice location:
  • Phone: 619-940-8546
  • Fax:
Mailing address:
  • Phone: 619-940-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number1056704
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number1056704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: