Provider Demographics
NPI:1679786677
Name:HERNANDEZ, MARCO A (DC)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 E LARKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3825
Mailing Address - Country:US
Mailing Address - Phone:626-919-7001
Mailing Address - Fax:626-919-7002
Practice Address - Street 1:1041 E LARKWOOD ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3825
Practice Address - Country:US
Practice Address - Phone:626-919-7001
Practice Address - Fax:626-919-7002
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor