Provider Demographics
NPI:1235654815
Name:HERNANDEZ, ERROL DANIEL
Entity Type:Individual
Prefix:
First Name:ERROL
Middle Name:DANIEL
Last Name: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 1:540 S EREMLAND DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3186
Mailing Address - Country:US
Mailing Address - Phone:626-966-1577
Mailing Address - Fax:
Practice Address - Street 1:560 S SAN JOSE AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3144
Practice Address - Country:US
Practice Address - Phone:626-967-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker