Basic Information
| Provider Information | |||||||||
| NPI: | 1699706952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | OSCAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 E COLLEGE BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882015158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104530419 | ||||||||
| FaxNumber: | 3108291960 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 SANTA MONICA BLVD | ||||||||
| Address2: | SUITE 680W | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104530419 | ||||||||
| FaxNumber: | 3108291960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 07/03/2017 | ||||||||
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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 | 207R00000X | A72896 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A728960 | 05 | CA | MEDICAID |