Provider Demographics
NPI:1871520320
Name:HERNANDEZ, VALENTIN (MD)
Entity type:Individual
Prefix:
First Name:VALENTIN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13440 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5806
Mailing Address - Country:US
Mailing Address - Phone:310-219-0941
Mailing Address - Fax:310-219-1482
Practice Address - Street 1:13440 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5806
Practice Address - Country:US
Practice Address - Phone:310-219-0941
Practice Address - Fax:310-219-1482
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330118591OtherFEIN
CA0623606OtherCHAMPUS OR CHAMPVA
CA00G402290Medicaid
CA$$$$$$$$$OtherSSN
CA00G402290Medicaid