Provider Demographics
NPI:1992897508
Name:HERNANDEZ, VIVIEN D (MD)
Entity type:Individual
Prefix:MRS
First Name:VIVIEN
Middle Name:D
Last Name:HERNANDEZ
Suffix:
Gender:F
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:PO BOX 1587
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1537
Mailing Address - Country:US
Mailing Address - Phone:650-991-3404
Mailing Address - Fax:650-991-3337
Practice Address - Street 1:341 WESTLAKE CENTER
Practice Address - Street 2:SUITE 317
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1356
Practice Address - Country:US
Practice Address - Phone:650-991-3404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3776670208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
5381017Medicare UPIN
CAA376670Medicare ID - Type Unspecified