Healthcare Provider Details

I. General information

NPI: 1952404808
Provider Name (Legal Business Name): ROBERT HAROLD HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 FREMONT BLVD
SEASIDE CA
93955-5715
US

IV. Provider business mailing address

PO BOX 43 SUITE 100
KOTZEBUE AK
99752-0043
US

V. Phone/Fax

Practice location:
  • Phone: 831-899-8100
  • Fax:
Mailing address:
  • Phone: 831-796-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA62147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: