Provider Demographics
NPI:1902550361
Name:LUCAS HERNANDEZ PT INC
Entity type:Organization
Organization Name:LUCAS HERNANDEZ PT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:661-313-1056
Mailing Address - Street 1:2526 HYPERION AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-3352
Mailing Address - Country:US
Mailing Address - Phone:661-313-1056
Mailing Address - Fax:213-289-2546
Practice Address - Street 1:2526 HYPERION AVE STE 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-3352
Practice Address - Country:US
Practice Address - Phone:661-313-1056
Practice Address - Fax:213-289-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty