Healthcare Provider Details

I. General information

NPI: 1992867535
Provider Name (Legal Business Name): EDWARD FIDEL HERNANDEZ R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523 EL PORTAL DR SUITE 103
SAN PABLO CA
94806-3305
US

IV. Provider business mailing address

520 ADAMS ST
ALBANY CA
94706-1106
US

V. Phone/Fax

Practice location:
  • Phone: 510-215-3730
  • Fax: 510-215-3731
Mailing address:
  • Phone: 707-536-3077
  • Fax: 707-536-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number387107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: