Provider Demographics
NPI:1487704631
Name:HERNANDEZ, MARIA R (DDS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:R
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 E AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3840
Mailing Address - Country:US
Mailing Address - Phone:661-729-1818
Mailing Address - Fax:661-729-1819
Practice Address - Street 1:1020 E AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-3840
Practice Address - Country:US
Practice Address - Phone:661-729-1818
Practice Address - Fax:661-729-1819
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9333201OtherMEDI-CAL PROVIDER NUMBER