Provider Demographics
NPI:1942816509
Name:HERNANDEZ, MAURICIO (RCP, RRT)
Entity Type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RCP, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 SANTA ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-3425
Mailing Address - Country:US
Mailing Address - Phone:626-698-8613
Mailing Address - Fax:
Practice Address - Street 1:1045 ATLANTIC AVE STE 616
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3411
Practice Address - Country:US
Practice Address - Phone:562-283-8486
Practice Address - Fax:562-352-2146
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2278P1005X
2279P1005X
CA283912279P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Function Technologist
No2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Rehabilitation
No2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Rehabilitation