Provider Demographics
NPI:1003110875
Name:VIRGIL HERNANDEZ DPM AACFAS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:VIRGIL HERNANDEZ DPM AACFAS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-265-5824
Mailing Address - Street 1:22851 MAIDEN LN
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4747
Mailing Address - Country:US
Mailing Address - Phone:714-265-5824
Mailing Address - Fax:714-384-3897
Practice Address - Street 1:801 N TUSTIN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3612
Practice Address - Country:US
Practice Address - Phone:714-265-5824
Practice Address - Fax:714-384-3897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty