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NPI Code Detail

MEDICARE: GERARDO DANIEL HERNANDEZ MD

MEDICARE: GERARDO DANIEL HERNANDEZ MD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine PhysicianA154073CA

General Provider Information

NPI Number : 1417356916
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERARDO DANIEL HERNANDEZ MD
Provider Business Mailing Address
First Line : 8627 ATLANTIC AVE
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-3501
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8627 ATLANTIC AVE
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-3501
Country : US
Telephone Number : 323-201-3218
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2014
Last Update Date : 08/13/2020

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