Provider Demographics
NPI:1578288122
Name:HERNANDEZ, DANIEL ANDRES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANDRES
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15611 PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3154
Mailing Address - Country:US
Mailing Address - Phone:909-573-5749
Mailing Address - Fax:
Practice Address - Street 1:12100 W OLYMPIC BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1049
Practice Address - Country:US
Practice Address - Phone:310-878-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist