Provider Demographics
NPI:1316496490
Name:HERNANDEZ, MANUEL V SR
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:V
Last Name:HERNANDEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SUN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3761
Mailing Address - Country:US
Mailing Address - Phone:831-783-3060
Mailing Address - Fax:831-783-3065
Practice Address - Street 1:29 SUN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3761
Practice Address - Country:US
Practice Address - Phone:831-783-3060
Practice Address - Fax:831-783-3065
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator