Basic Information
Provider Information
NPI: 1427545698
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERNANDEZ
FirstName: ROBERT
MiddleName: FRANCIS
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2050 S BLOSSER RD
Address2:  
City: SANTA MARIA
State: CA
PostalCode: 934587310
CountryCode: US
TelephoneNumber: 8053618030
FaxNumber: 8053618097
Practice Location
Address1: 430 S BLOSSER RD
Address2:  
City: SANTA MARIA
State: CA
PostalCode: 934584908
CountryCode: US
TelephoneNumber: 8053618900
FaxNumber: 8053618990
Other Information
ProviderEnumerationDate: 04/13/2018
LastUpdateDate: 06/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X95008801CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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