Provider Demographics
NPI:1700569951
Name:HERNANDEZ, ADAM COLTEN (DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:COLTEN
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 1:42200 MARGARITA RD APT 1011
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5439
Mailing Address - Country:US
Mailing Address - Phone:909-287-4176
Mailing Address - Fax:
Practice Address - Street 1:38860 SKY CANYON DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2518
Practice Address - Country:US
Practice Address - Phone:951-304-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist