MEDICARE: MRS. VIVIEN D 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
1	208000000X	Pediatrics Physician	A3776670	CA

General Provider Information

NPI Number	:	1992897508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIVIEN D HERNANDEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 1587
Second Line	:
City	:	MILLBRAE
State	:	CA
Zip	:	94030-1537
Country	:	US
Telephone Number	:	650-991-3404
Fax Number	:	650-991-3337

Provider Business Practice Location Address
First Line	:	341 WESTLAKE CENTER
Second Line	:	SUITE 317
City	:	DALY CITY
State	:	CA
Zip	:	94015-1356
Country	:	US
Telephone Number	:	650-991-3404
Fax Number	:

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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