Provider Demographics
NPI:1033959283
Name:HERNANDEZ, ANTHONY B
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
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 1:15540 MOORPARK ST APT 12
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1600
Mailing Address - Country:US
Mailing Address - Phone:818-614-7541
Mailing Address - Fax:
Practice Address - Street 1:15540 MOORPARK ST APT 12
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1600
Practice Address - Country:US
Practice Address - Phone:818-614-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95386225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist