Provider Demographics
NPI:1144231994
Name:OJEDA, HERMINIO (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMINIO
Middle Name:
Last Name:OJEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2030 SUTTER PL
Practice Address - Street 2:SUITE 1000
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6212
Practice Address - Country:US
Practice Address - Phone:530-750-5890
Practice Address - Fax:530-750-5859
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4616208600000X
CAC53549208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168777401Medicaid
TX168777401OtherCIDC
TX168777401Medicaid
CACW484ZMedicare PIN