Individual provider Active NPI

Yesenia Hernandez, PA-C

  • Physician Assistant
  • Victorville, CA
National Provider Identifier
1801576350
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA63318 Issued in CA
Practice address
16850 Bear Valley Rd
Victorville, CA 92395-5794
Phone
(760) 381-8061
NPI assigned
Jul 20, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X PA63318 CA Primary

Addresses

Primary practice location

16850 Bear Valley Rd
Victorville, CA 92395-5794

Mailing address

19449 Katydid Ave
Bloomington, CA 92316-3805

Other practice location 1

309 E 2nd St
Pomona, CA 91766-1854
Phone (909) 623-6116

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231207001989 CA Practitioner - Physician Assistant 4284083858 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

16850 Bear Valley Rd
Victorville, CA 92395-5795

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA63318CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Valley Medical Group, Inc CurrentSince Nov 13, 2023 Accepting new patients
Desert Valley Medical Group, Inc CurrentSince Nov 13, 2023 Accepting new patients
Desert Valley Hospital, LLC Past Accepting new patients

Locations

16850 Bear Valley Rd
Victorville, CA 92395
Phone (760) 241-8222

16850 Bear Valley Rd
Ste 100
Victorville, CA 92395

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1689811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1801576350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19449 KATYDID AVE",
            "city": "BLOOMINGTON",
            "state": "CA",
            "postal_code": "923163805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16850 BEAR VALLEY RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955794",
            "telephone_number": "760-381-8061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "309 E 2nd St",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917661854",
            "country_code": "US",
            "telephone_number": "909-623-6116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "YESENIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-20",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA63318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.