Provider Demographics
NPI:1396760369
Name:HERNANDEZ, ANTONIO (DPT)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
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 1:2107 EL PORTAL DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-1777
Mailing Address - Country:US
Mailing Address - Phone:209-388-9143
Mailing Address - Fax:
Practice Address - Street 1:3327 M ST
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2714
Practice Address - Country:US
Practice Address - Phone:209-722-1030
Practice Address - Fax:209-722-5408
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT220990Medicare ID - Type Unspecified
CAS70460Medicare UPIN