Healthcare Provider Details

I. General information

NPI: 1376824128
Provider Name (Legal Business Name): MR. OSCAR HERNANDEZ- MIRANDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E BEACH ST
WATSONVILLE CA
95076-4809
US

IV. Provider business mailing address

PO BOX 1870
WATSONVILLE CA
95077-1870
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0222
  • Fax: 831-707-2777
Mailing address:
  • Phone: 831-728-8250
  • Fax: 831-707-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: