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General NPI Number Information
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NPI Number | 1720181282
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Entity Type | Individual
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Provider Name | BENJAMIN A. HERNANDEZ VELASCO MD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 1165 MONTGOMERY DR
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City | SANTA ROSA
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State | CA
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Zip | 95405-4801
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Country | US
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Telephone | 707-547-5437
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Fax | 707-547-5430
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Provider Business Mailing Address
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Address Line | 200 W CENTER STREET PROMENADE STE 400
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City | ANAHEIM
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State | CA
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Zip | 92805-3960
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Country | US
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Telephone | 714-449-4800
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Fax | 714-449-4956
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 13840
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 13840
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 13840
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License Number State | PR
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C150323
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License Number State | CA
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