Provider Demographics
NPI:1063757292
Name:HERNANDEZ, OSCAR (CMP , DAOM)
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:CMP , DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 E BEACH ST STE 214
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4642
Mailing Address - Country:US
Mailing Address - Phone:831-319-4770
Mailing Address - Fax:831-222-3044
Practice Address - Street 1:23 E BEACH ST STE 214
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4642
Practice Address - Country:US
Practice Address - Phone:831-319-4770
Practice Address - Fax:831-222-3044
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist