Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1033493804 |
---|---|
Provider Name | Jose Leonardo Hernandez |
First Address | Van Nuys, CA 91401-2346 |
Second Address | Van Nuys, CA 91401-2346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2011 |
Last Update Date | 19/03/2019 |