Healthcare Provider Details

I. General information

NPI: 1568277879
Provider Name (Legal Business Name): OSCAR HERNANDEZ NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S PACIFIC AVE
SAN PEDRO CA
90731-2656
US

IV. Provider business mailing address

11120 CHANDLER BLVD
NORTH HOLLYWOOD CA
91601-4369
US

V. Phone/Fax

Practice location:
  • Phone: 310-519-8723
  • Fax:
Mailing address:
  • Phone: 818-815-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: