Provider Demographics
NPI:1053861237
Name:HERNANDEZ, PABLO
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:HERNANDEZ
Suffix:
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 1:2008 FRANCISCAN WAY APT 202
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6102
Mailing Address - Country:US
Mailing Address - Phone:760-421-1856
Mailing Address - Fax:
Practice Address - Street 1:2008 FRANCISCAN WAY APT 202
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6102
Practice Address - Country:US
Practice Address - Phone:760-421-1856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker