MEDICARE: MICHAEL 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
1	363LF0000X	Family Nurse Practitioner	95242066	CA

General Provider Information

NPI Number	:	1609708569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HERNANDEZ

Provider Business Mailing Address
First Line	:	15995 ALLISON WAY
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-5056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15995 ALLISON WAY
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-5056
Country	:	US
Telephone Number	:	909-453-5750
Fax Number	:

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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