Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 39405 | CA |
NPI | 1003155136 |
---|---|
Provider Name | Dr. Rogelio Hernandez JR. |
First Address | San Diego, CA 92110-1987 |
Second Address | San Diego, CA 92110-1987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2013 |
Last Update Date | 09/02/2013 |