Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G26992 | CA |
NPI | 1043363997 |
---|---|
Provider Name | Dr. John J Hernandez |
First Address | Westlake Village, CA 91361 |
Second Address | Westlake Village, CA 91361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A43172 | (02) | |
G26992 | MEDICAL LICENSE (01) | CA |