Provider Demographics
NPI:1275087868
Name:HERNANDEZ, ALEXIS (DDS)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S COCHRAN AVE
Mailing Address - Street 2:APT. #202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5900
Mailing Address - Country:US
Mailing Address - Phone:619-392-7822
Mailing Address - Fax:
Practice Address - Street 1:612 S COCHRAN AVE
Practice Address - Street 2:APT. #202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5900
Practice Address - Country:US
Practice Address - Phone:619-392-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist