Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | A107450 | CA |
Y | 208000000X | Pediatrician | A107450 | CA |
NPI | 1104052232 |
---|---|
Provider Name | Dr. Joseph Demetrius Hernandez |
First Address | Stanford, CA 94305-5366 |
Second Address | Stanford, CA 94305-5366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2009 |
Last Update Date | 12/07/2013 |