Provider Information for 1992104848
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EDWIN DANIEL HERNANDEZ
Sex: Male
NPI: 1992104848
Last Updated: 2023-12-29
Certification Date: 2023-12-28
Certification Date: 2023-12-28
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1992104848 | ||||||||||||||||
| Enumeration Date | 2014-08-16 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 333 S BEAUDRY AVE LOS ANGELES, CA 90017-1466 United States Phone: 213-241-3841 | Fax:213-241-3305 | ||||||||||||||||
| Primary Practice Address | 333 S BEAUDRY AVE LOS ANGELES, CA 90017-1466 United States Phone: 213-241-3841 | Fax:213-241-3305 | ||||||||||||||||
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