Michael Hermansen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

CA53910 Issued in CA

Practice address

3851 Katella Ave Ste 100
Los Alamitos, CA 90720-3385

Phone

(562) 424-5450

Fax

(562) 430-8687

NPI assigned

Oct 8, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1475884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557360000000",
    "number": "1528518073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9209 REDBUD LN",
            "city": "LENEXA",
            "state": "KS",
            "postal_code": "662203441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3851 KATELLA AVE STE 100",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203385",
            "telephone_number": "562-424-5450",
            "fax_number": "562-430-8687"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 North Sepulveda Boulevard",
            "address_2": "Suite 210",
            "address_purpose": "LOCATION",
            "city": "Manhattan Beach",
            "state": "CA",
            "postal_code": "90266",
            "country_code": "US",
            "telephone_number": "310-379-2134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERMANSEN",
        "first_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-08",
        "last_updated": "2019-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "CA53910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528518073",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Elizabeth Henning, M.S., R.D.
• Kirsten Henriquez
• Mellissa Henry, FNP
• Ward James Henry III, D.C.
• Rhisie Hentges, LMFT
• Kenya Hernandez
• Yasmin Herring, MD
• Lisa Hertz, MD
• Hollis K. Hettig, M.S., MFT
• Gretchen Ann Hetzler, M.D..

• Physician Assistant in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.