Provider Demographics
NPI:1871099317
Name:HERNANDEZ, RAUL JR
Entity type:Individual
Prefix:MR
First Name:RAUL
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-2716
Mailing Address - Country:US
Mailing Address - Phone:415-554-8494
Mailing Address - Fax:415-554-8444
Practice Address - Street 1:234 EDDY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2716
Practice Address - Country:US
Practice Address - Phone:415-554-8494
Practice Address - Fax:415-554-8444
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker