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General NPI Number Information
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NPI Number | 1992867535
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Entity Type | Individual
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Provider Name | EDWARD FIDEL HERNANDEZ R.N.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 2523 EL PORTAL DR SUITE 103
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City | SAN PABLO
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State | CA
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Zip | 94806-3305
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Country | US
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Telephone | 510-215-3730
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Fax | 510-215-3731
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Provider Business Mailing Address
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Address Line | 520 ADAMS ST
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City | ALBANY
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State | CA
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Zip | 94706-1106
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Country | US
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Telephone | 707-536-3077
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Fax | 707-536-3077
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 387107
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License Number State | CA
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