Basic Information
| Provider Information | |||||||||
| NPI: | 1669033908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | ULISSES | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 W 49TH ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900373203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233844990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2101 7TH ST | ||||||||
| Address2: | |||||||||
| City: | WASCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932801502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667076664 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2019 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | PTL1182 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 20A20036 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.