Provider Demographics
NPI:1598790479
Name:HERNANDEZ, OSCAR-ALFONSO CHAVEZ (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR-ALFONSO
Middle Name:CHAVEZ
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3832
Mailing Address - Country:US
Mailing Address - Phone:559-784-2176
Mailing Address - Fax:559-784-2176
Practice Address - Street 1:139 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3832
Practice Address - Country:US
Practice Address - Phone:559-784-2176
Practice Address - Fax:559-784-2176
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG072101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG072101OtherCA LIC. #
CA00G072101Medicaid
CABH3231191OtherDEA
CABH3231191OtherDEA