Provider Demographics
NPI:1316687866
Name:HERNANDEZ, MONICA MARIE (DO)
Entity type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:MONICA
Other - Middle Name:MARIE
Other - Last Name:BERNAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:6082 BANNOCK RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-1922
Mailing Address - Country:US
Mailing Address - Phone:213-703-7629
Mailing Address - Fax:
Practice Address - Street 1:1900 E 4TH ST FL 1
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3910
Practice Address - Country:US
Practice Address - Phone:866-353-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A21481207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program