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General NPI Number Information
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NPI Number | 1619186848
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Entity Type | Organization
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Legal Business Name | DRS. EDWARD P. AND DIANE M. HERNANDEZ, O.D.
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 1235 BUENA VISTA ST
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City | DUARTE
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State | CA
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Zip | 91010-2408
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Country | US
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Telephone | 626-359-8145
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Fax | 626-359-4116
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Provider Business Mailing Address
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Address Line | 1235 BUENA VISTA ST
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City | DUARTE
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State | CA
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Zip | 91010-2408
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Country | US
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Telephone | 626-359-8145
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Fax | 626-359-4116
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIANE MOSSER HERNANDEZ
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Credential | O.D.
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Telephone | 626-359-8145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 08738T
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License Number State | CA
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