Provider Demographics
NPI:1114680584
Name:HERNANDEZ, ELIOT (RT(R))
Entity Type:Individual
Prefix:
First Name:ELIOT
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 CONTRA COSTA BLVD APT 64
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2428
Mailing Address - Country:US
Mailing Address - Phone:408-799-0346
Mailing Address - Fax:
Practice Address - Street 1:3140 BALFOUR ROAD SUITES C
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CALIFORNIA (CA)
Practice Address - Zip Code:94513
Practice Address - Country:US
Practice Address - Phone:925-626-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10266022471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography