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General NPI Number Information
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NPI Number | 1275906471
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Entity Type | Organization
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Legal Business Name | RUTH HERNANDEZ M.D MEDICAL PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 16498 VICTOR ST
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City | VICTORVILLE
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State | CA
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Zip | 92395
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Country | US
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Telephone | 760-243-3033
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Fax | 760-243-3633
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Provider Business Mailing Address
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Address Line | 16498 VICTOR ST
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City | VICTORVILLE
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State | CA
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Zip | 92395
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Country | US
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Telephone | 760-243-3033
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Fax | 760-243-3633
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Authorized Official
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Title or Position | DOCTOR
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Name | MRS. RUTH HERNANDEZ
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Credential | M.D.
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Telephone | 951-531-7242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A87453
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License Number State | CA
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