Provider Demographics
NPI:1699706952
Name:HERNANDEZ, OSCAR (MD)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
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 1:115 E COLLEGE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5158
Mailing Address - Country:US
Mailing Address - Phone:310-453-0419
Mailing Address - Fax:310-829-1960
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 680W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-453-0419
Practice Address - Fax:310-829-1960
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A728960Medicaid
CAH43903Medicare UPIN
CA00A728960Medicaid