Provider Demographics
NPI:1700879897
Name:HERNANDEZ, RUBEN A (MD)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44215 15TH STREET WEST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5055
Mailing Address - Country:US
Mailing Address - Phone:661-945-4581
Mailing Address - Fax:661-949-5587
Practice Address - Street 1:44215 15TH STREET WEST
Practice Address - Street 2:SUITE 315
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5055
Practice Address - Country:US
Practice Address - Phone:661-945-4581
Practice Address - Fax:661-949-5587
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2025-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA74132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H93653Medicare UPIN