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General NPI Number Information
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NPI Number | 1396255600
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Entity Type | Organization
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Legal Business Name | ERICK HERNANDEZ DDS, INC.
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 25095 JEFFERSON AVE STE 201
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City | MURRIETA
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State | CA
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Zip | 92562-9107
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Country | US
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Telephone | 951-698-0155
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Fax | 951-698-5071
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Provider Business Mailing Address
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Address Line | 25095 JEFFERSON AVE STE 201
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City | MURRIETA
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State | CA
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Zip | 92562-9107
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Country | US
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Telephone | 951-698-0155
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Fax | 951-698-5071
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Authorized Official
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Title or Position | DENTIST
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Name | ERICK M HERNANDEZ
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Credential | DDS
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Telephone | 951-698-0155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 56051
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License Number State | CA
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