Provider Demographics
NPI:1326706508
Name:HERNANDEZ DE RAMIREZ, LIDIA (DDS)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:
Last Name:HERNANDEZ DE RAMIREZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 RIGOLETTO DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1339
Mailing Address - Country:US
Mailing Address - Phone:408-757-7392
Mailing Address - Fax:
Practice Address - Street 1:4767 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1600
Practice Address - Country:US
Practice Address - Phone:408-727-0722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1061121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice