Provider Demographics
NPI:1659387629
Name:HERNANDEZ, ROGELIO M (MD)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1130 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-1582
Mailing Address - Country:US
Mailing Address - Phone:559-673-3297
Mailing Address - Fax:559-673-3298
Practice Address - Street 1:1130 COUNTRY CLUB DR
Practice Address - Street 2:SUITE E
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-1582
Practice Address - Country:US
Practice Address - Phone:559-673-3297
Practice Address - Fax:559-673-3298
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA49249208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE25065Medicare UPIN