Provider Demographics
NPI:1962672709
Name:HERNANDEZ, LUCAS S (DPT)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:S
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 HYPERION AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-3352
Mailing Address - Country:US
Mailing Address - Phone:661-313-1056
Mailing Address - Fax:661-313-1056
Practice Address - Street 1:2526 HYPERION AVE STE 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-3352
Practice Address - Country:US
Practice Address - Phone:661-313-1056
Practice Address - Fax:661-313-1056
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist