Provider Demographics
NPI:1427233345
Name:FEDERICO R HERNANDEZ DPM A PROFESSIONAL CORP
Entity type:Organization
Organization Name:FEDERICO R HERNANDEZ DPM A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:760-352-6062
Mailing Address - Street 1:PO BOX 318
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-0318
Mailing Address - Country:US
Mailing Address - Phone:760-352-6062
Mailing Address - Fax:760-332-0400
Practice Address - Street 1:1665 S IMPERIAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4253
Practice Address - Country:US
Practice Address - Phone:760-352-6062
Practice Address - Fax:760-332-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1187213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801930318OtherINDIVIDUAL NPI
CA000E11871Medicaid
CA0993060001Medicare NSC
CA1801930318OtherINDIVIDUAL NPI
CAT10813Medicare UPIN