Provider Demographics
NPI:1396756912
Name:HERNANDEZ, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7012 RESEDA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4219
Mailing Address - Country:US
Mailing Address - Phone:747-265-6423
Mailing Address - Fax:
Practice Address - Street 1:7012 RESEDA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4219
Practice Address - Country:US
Practice Address - Phone:747-265-6423
Practice Address - Fax:747-265-6424
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48343207QA0505X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70769FOtherPROG GRP #
CAFHC70769FMedicaid
CAP00275711OtherMEDICARE RAILROAD #
CABCP70769FOtherCDC PROGRAM GRP #
CAEAP70468FOtherPROGRAM GRP #
CAEAP70468FOtherPROGRAM GRP #
CAFHC70769FMedicaid
CAFHC70769FMedicaid
CA1538130893Medicaid