Provider Demographics
NPI:1114907706
Name:HERNANDEZ, FRANCISCO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:ANTONIO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FRANK
Other - Middle Name:A
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4562 PASEO DE LA VISTA
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1255
Mailing Address - Country:US
Mailing Address - Phone:619-997-4410
Mailing Address - Fax:619-472-0386
Practice Address - Street 1:4562 PASEO DE LA VISTA
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1255
Practice Address - Country:US
Practice Address - Phone:619-997-4410
Practice Address - Fax:619-472-0386
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36108208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A36108Medicaid
CAGR0062500OtherMEDICAID GRP#
CA00A36108Medicaid
CAW13244Medicare PIN