Provider Demographics
NPI:1114093317
Name:HERNANDEZ, XAVIER C (RT)
Entity Type:Individual
Prefix:MR
First Name:XAVIER
Middle Name:C
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RT
Other - Prefix:MR
Other - First Name:XAVIER
Other - Middle Name:C
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RT
Mailing Address - Street 1:404 MILE OF CARS WAY
Mailing Address - Street 2:SUITE # D
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-6660
Mailing Address - Country:US
Mailing Address - Phone:619-477-4934
Mailing Address - Fax:619-477-1592
Practice Address - Street 1:404 MILE OF CARS WAY
Practice Address - Street 2:SUITE # D
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-6660
Practice Address - Country:US
Practice Address - Phone:619-477-4934
Practice Address - Fax:619-477-1592
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHT70122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG014Medicare ID - Type UnspecifiedMEDICAL PROVIDER