Active NPI
Justin Hernandez, R.N.
- Registered Nurse
- Los Angeles, CA
National Provider Identifier
1558613190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 806870
- Practice address
- 1625 Schrader Blvd
Los Angeles, CA 90028-6213 - Phone
- (323) 993-7524
- Fax
- (323) 308-4186
- NPI assigned
- Oct 5, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 806870 | CA | Primary |
Addresses
Primary practice location
1625 Schrader Blvd
Los Angeles, CA 90028-6213
Mailing address
1625 Schrader Blvd
Los Angeles, CA 90028-6213
Phone (323) 993-7524
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01261511 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 806870 | CA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349395200000",
"number": "1558613190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1625 SCHRADER BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900286213",
"telephone_number": "323-993-7524",
"fax_number": "323-308-4186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 SCHRADER BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900286213",
"telephone_number": "323-993-7524",
"fax_number": "323-308-4186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERNANDEZ",
"first_name": "JUSTIN",
"credential": "R.N.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-05",
"last_updated": "2012-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "806870",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01261511",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.