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General NPI Number Information
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NPI Number | 1043363997
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Entity Type | Individual
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Provider Name | JOHN J HERNANDEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1250 LA VENTA DRIVE, SUITE 110
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361
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Country | US
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Telephone | 818-889-3230
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Fax | 805-379-4733
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Provider Business Mailing Address
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Address Line | 1250 LA VENTA DRIVE, SUITE 110
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361
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Country | US
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Telephone | 818-889-3230
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Fax | 805-379-4733
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | G26992
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License Number State | CA
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