MEDICARE: DAVID DON RAFAEL 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	225400000X	Rehabilitation Practitioner		CA

General Provider Information

NPI Number	:	1801562707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DON RAFAEL HERNANDEZ

Provider Business Mailing Address
First Line	:	2975 MCMILLAN AVE STE 164
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-6768
Country	:	US
Telephone Number	:	805-439-4890
Fax Number	:

Provider Business Practice Location Address
First Line	:	2975 MCMILLAN AVE STE 164
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-6768
Country	:	US
Telephone Number	:	805-439-4890
Fax Number	:

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

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	02/10/2026

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