Provider Demographics
NPI:1932703642
Name:HERNANDEZ, RODRIGO
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
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 1:5715 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-4131
Mailing Address - Country:US
Mailing Address - Phone:323-948-0444
Mailing Address - Fax:323-948-0443
Practice Address - Street 1:3010 E VICTORIA ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-5617
Practice Address - Country:US
Practice Address - Phone:424-403-5800
Practice Address - Fax:424-403-5802
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator