Provider Demographics
NPI:1962040998
Name:HERNANDEZ, MARGARITA (DPT)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 CRESTON RD STE 115
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-3033
Mailing Address - Country:US
Mailing Address - Phone:805-239-3696
Mailing Address - Fax:805-239-3697
Practice Address - Street 1:1545 HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2917
Practice Address - Country:US
Practice Address - Phone:805-543-5633
Practice Address - Fax:805-543-5990
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT294429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT294429OtherPT LICENCE