Provider Demographics
NPI:1992691687
Name:HERNANDEZ, CHRISTIAN ULYSSES
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ULYSSES
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 GILMAN DR # 60119
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92092-0102
Mailing Address - Country:US
Mailing Address - Phone:619-728-5065
Mailing Address - Fax:
Practice Address - Street 1:501 W BROADWAY STE 1540
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3770
Practice Address - Country:US
Practice Address - Phone:619-728-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator