Basic Information
| Provider Information | |||||||||
| NPI: | 1598069775 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | MANUEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8033 N GLENN AVE APT 106 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937116804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108568979 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2755 HERNDON AVE | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936116800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593244000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2011 | ||||||||
| LastUpdateDate: | 05/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A119284 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.