MEDICARE: JUAN CARLOS 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	167G00000X	Licensed Psychiatric Technician	42914	CA

General Provider Information

NPI Number	:	1740169473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CARLOS HERNANDEZ

Provider Business Mailing Address
First Line	:	300 E 15TH ST
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95341-6217
Country	:	US
Telephone Number	:	209-381-6819
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E 15TH ST
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95341-6217
Country	:	US
Telephone Number	:	209-381-6819
Fax Number	:

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

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	03/09/2026

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Directions to “ JUAN CARLOS HERNANDEZ ” Practice Location

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