MEDICARE: GERARDO ANDRES HERNANDEZ RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86472673	IL

General Provider Information

NPI Number	:	1528993110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARDO ANDRES HERNANDEZ RDN

Provider Business Mailing Address
First Line	:	1223 EUCLID AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-1006
Country	:	US
Telephone Number	:	708-973-4399
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 EUCLID AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-1006
Country	:	US
Telephone Number	:	708-973-4399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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