Provider Demographics
NPI:1811078421
Name:HERNANDEZ-LINARES, WILFREDO (MD)
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:HERNANDEZ-LINARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILFREDO
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 67779
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067
Mailing Address - Country:US
Mailing Address - Phone:310-273-7365
Mailing Address - Fax:310-273-7366
Practice Address - Street 1:201 S ALVARADO
Practice Address - Street 2:SUITE 815
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:223-481-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26402207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A264020Medicaid
A26402Medicare ID - Type Unspecified
CA00A264020Medicaid