Provider Demographics
NPI:1538248059
Name:HERNANDEZ, STEVE J (PA)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:J
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6280 JACKSON DR
Mailing Address - Street 2:STE#8
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3434
Mailing Address - Country:US
Mailing Address - Phone:619-464-1607
Mailing Address - Fax:619-461-8662
Practice Address - Street 1:6280 JACKSON DR
Practice Address - Street 2:STE#8
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3434
Practice Address - Country:US
Practice Address - Phone:619-464-1607
Practice Address - Fax:619-461-8662
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12020OtherPA LICENSE