MEDICARE: DR. LEOPOLDO G. HERNANDEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	G39635	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144327008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEOPOLDO G. HERNANDEZ M.D.

Provider Business Mailing Address
First Line	:	3406 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1708
Country	:	US
Telephone Number	:	323-261-3161
Fax Number	:	323-261-2618

Provider Business Practice Location Address
First Line	:	3406 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1708
Country	:	US
Telephone Number	:	323-261-3161
Fax Number	:	323-261-2618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/01/2007

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