Healthcare Provider Details

I. General information

NPI: 1558284273
Provider Name (Legal Business Name): JESSE HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 S TUSCANY DOWNS WAY
WEST VALLEY CITY UT
84128-7154
US

IV. Provider business mailing address

3132 S TUSCANY DOWNS WAY
WEST VALLEY CITY UT
84128-7154
US

V. Phone/Fax

Practice location:
  • Phone: 801-856-8051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11288014-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95266364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: