Provider Demographics
NPI:1003155136
Name:HERNANDEZ, ROGELIO JR (DPT)
Entity Type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 SAN DIEGO AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1987
Mailing Address - Country:US
Mailing Address - Phone:619-291-1959
Mailing Address - Fax:
Practice Address - Street 1:1764 SAN DIEGO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-1987
Practice Address - Country:US
Practice Address - Phone:619-291-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-09
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39405208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation