Provider Demographics
NPI:1952454449
Name:HERNANDEZ, MARK D
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:D
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9504 PASEO DE LOS CASTILLOS
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4185
Mailing Address - Country:US
Mailing Address - Phone:619-334-6959
Mailing Address - Fax:
Practice Address - Street 1:BLDG, H100, SANTA MARGARITA ROAD
Practice Address - Street 2:
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-9151
Practice Address - Country:US
Practice Address - Phone:760-725-8882
Practice Address - Fax:760-725-1267
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056186207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services