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NPI Code Detail

MEDICARE: LUIS ANTONIO HERNANDEZ

MEDICARE: LUIS ANTONIO HERNANDEZ
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
1175T00000XPeer SpecialistCA

General Provider Information

NPI Number : 1568161180
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUIS ANTONIO HERNANDEZ
Provider Business Mailing Address
First Line : 202 N 8TH ST
Second Line :
City : EL CENTRO
State : CA
Zip : 92243-2302
Country : US
Telephone Number : 442-265-7200
Fax Number : 442-265-7206
Provider Business Practice Location Address
First Line : 202 N 8TH ST
Second Line :
City : EL CENTRO
State : CA
Zip : 92243-2302
Country : US
Telephone Number : 442-265-7200
Fax Number : 442-265-7206
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2023
Last Update Date : 03/25/2026

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Directions to “ LUIS ANTONIO HERNANDEZ ” Practice Location

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