Provider Demographics
NPI:1831103548
Name:FERNANDEZ, HECTOR JIMENEZ (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:JIMENEZ
Last Name:FERNANDEZ
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 1:1970 OLD TUSTIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7865
Mailing Address - Country:US
Mailing Address - Phone:714-542-0102
Mailing Address - Fax:714-479-0709
Practice Address - Street 1:1970 OLD TUSTIN AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7865
Practice Address - Country:US
Practice Address - Phone:714-542-0102
Practice Address - Fax:714-479-0709
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32020261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA953526447OtherIRS TAX PAYER ID
CA0G320200Medicaid
CAG32020Medicare ID - Type Unspecified
CA0G320200Medicaid