Basic Information
| Provider Information | |||||||||
| NPI: | 1740290535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | GIAN | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19042 SOLEDAD CANYON RD | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913513362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612516300 | ||||||||
| FaxNumber: | 6612516303 | ||||||||
| Practice Location | |||||||||
| Address1: | 44750 60TH ST W | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935367619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617292000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 11/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A8740 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 20A8740 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 20A8740 | 01 | CA | MEDICAL LICENSE | OTHER |