Provider Demographics
NPI:1487615449
Name:HERNANDEZ, DANIEL I (MD)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:I
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:PO BOX 27890
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-7890
Mailing Address - Country:US
Mailing Address - Phone:559-538-3080
Mailing Address - Fax:559-538-3090
Practice Address - Street 1:1187 E HERNDON AVE
Practice Address - Street 2:STE 106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3166
Practice Address - Country:US
Practice Address - Phone:559-224-0900
Practice Address - Fax:559-441-4271
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC143962207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H82233Medicare UPIN
PR0020232Medicare PIN
H82233Medicare UPIN