Provider Demographics
NPI:1174286884
Name:SILVA HERNANDEZ, LUIS MANUEL
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:MANUEL
Last Name:SILVA 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 1:8440 CLETA ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4904
Mailing Address - Country:US
Mailing Address - Phone:626-540-8468
Mailing Address - Fax:
Practice Address - Street 1:200 PINE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3041
Practice Address - Country:US
Practice Address - Phone:562-370-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator