Provider Demographics
NPI:1730295189
Name:HERNANDEZ, LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
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 1:405 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-2439
Mailing Address - Country:US
Mailing Address - Phone:559-661-0247
Mailing Address - Fax:559-661-0744
Practice Address - Street 1:405 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-2439
Practice Address - Country:US
Practice Address - Phone:559-661-0247
Practice Address - Fax:559-661-0744
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A444470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A444470Medicare ID - Type UnspecifiedSTATE LICENSE NUMBER