Provider Demographics
NPI:1326282385
Name:AMEZCUA, HERMINIA (MD)
Entity Type:Individual
Prefix:
First Name:HERMINIA
Middle Name:
Last Name:AMEZCUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44105 15TH ST W STE 405
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4000
Mailing Address - Country:US
Mailing Address - Phone:661-729-7100
Mailing Address - Fax:
Practice Address - Street 1:44105 15TH ST W STE 405
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4000
Practice Address - Country:US
Practice Address - Phone:661-729-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126117207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology