Active NPI
Amy Hernandez
- Surgery Physician
- San Diego, CA
National Provider Identifier
1821226143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 54950-020
- Practice address
- 34800 Bob Wilson Dr
General Surgery Dept - Building 3 Deck 4
San Diego, CA 92134 - Phone
- (619) 532-7575
- NPI assigned
- Jun 25, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 54950-020 | WI | Primary |
| Surgery Physician | 208600000X | C174585 | CA |
Addresses
Primary practice location
34800 Bob Wilson Dr
General Surgery Dept - Building 3 Deck 4
San Diego, CA 92134
Mailing address
34800 Bob Wilson Dr
General Surgery Dept - Building 3 Deck 4
San Diego, CA 92134
Other practice location 1
200 Mercy Circle
General Surgery Department
Camp Pendleton, CA 92055
Phone (760) 725-1356
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190308002765 | WI | Order and Referring Only - General Surgery | 0648519629 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C174585 | CA | MD | Surgery Physician |
| 54950-020 | WI | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703548800000",
"number": "1821226143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34800 BOB WILSON DR",
"address_2": "GENERAL SURGERY DEPT - BUILDING 3 DECK 4",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34800 BOB WILSON DR",
"address_2": "GENERAL SURGERY DEPT - BUILDING 3 DECK 4",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92134",
"telephone_number": "619-532-7575"
}
],
"practiceLocations": [
{
"address_1": "200 Mercy Circle",
"address_2": "General Surgery Department",
"address_purpose": "LOCATION",
"city": "Camp Pendleton",
"state": "CA",
"postal_code": "92055",
"country_code": "US",
"telephone_number": "760-725-1356",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HERNANDEZ",
"first_name": "AMY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-25",
"last_updated": "2023-12-26",
"certification_date": "2023-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "54950-020",
"primary": true
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "C174585",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2023; 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.