Provider Demographics
NPI:1669491205
Name:HERNANDEZ, JOSE ANGEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANGEL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 COFFEE RD
Mailing Address - Street 2:STE D
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4241
Mailing Address - Country:US
Mailing Address - Phone:209-581-1776
Mailing Address - Fax:209-549-1601
Practice Address - Street 1:817 COFFEE RD
Practice Address - Street 2:STE D
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4241
Practice Address - Country:US
Practice Address - Phone:209-581-1776
Practice Address - Fax:209-549-1601
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC022712Medicare PIN
CAU45153Medicare UPIN