Provider Demographics
NPI:1922338144
Name:HERNANDEZ, RICHARD J
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 E GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0920
Mailing Address - Country:US
Mailing Address - Phone:909-387-7384
Mailing Address - Fax:909-387-7386
Practice Address - Street 1:755 E GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0920
Practice Address - Country:US
Practice Address - Phone:909-387-7384
Practice Address - Fax:909-387-7386
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker