Provider Demographics
NPI:1740999739
Name:HERNANDEZ, RICARDO JR (PT DPT)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 REGALO DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5100
Mailing Address - Country:US
Mailing Address - Phone:760-899-8704
Mailing Address - Fax:
Practice Address - Street 1:32261 CAMINO CAPISTRANO STE D101
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3747
Practice Address - Country:US
Practice Address - Phone:949-429-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3031642251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic