=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396756912
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID J HERNANDEZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 11/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7012 RESEDA BLVD STE 100
-----------------------------------------------------
City | RESEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91335-4219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-265-6423
-----------------------------------------------------
Fax | 747-265-6424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7012 RESEDA BLVD STE 100
-----------------------------------------------------
City | RESEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91335-4219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-265-6423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | G48343
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G48343
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------