Provider Demographics
NPI:1760112239
Name:HERNANDEZ-HERNANDEZ, DOMINICK (DC)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:
Last Name:HERNANDEZ-HERNANDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21030 GRESHAM ST APT 505
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-7606
Mailing Address - Country:US
Mailing Address - Phone:818-590-7545
Mailing Address - Fax:
Practice Address - Street 1:10345 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2743
Practice Address - Country:US
Practice Address - Phone:562-287-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor