Provider Demographics
NPI:1124176482
Name:OSCAR HERNANDEZ MD MEDICAL CORPORATION
Entity type:Organization
Organization Name:OSCAR HERNANDEZ MD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:NYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-783-1181
Mailing Address - Street 1:139 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3832
Mailing Address - Country:US
Mailing Address - Phone:559-784-2176
Mailing Address - Fax:559-784-2652
Practice Address - Street 1:139 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3832
Practice Address - Country:US
Practice Address - Phone:559-784-2176
Practice Address - Fax:559-784-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G721010Medicaid
CA00G721010Medicaid