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NPI Code Detail

MEDICARE: DERRICK HERNANDEZ CRNA

MEDICARE: DERRICK HERNANDEZ CRNA
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
1367500000XCertified Registered Nurse Anesthetist676885TX

General Provider Information

NPI Number : 1609868157
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK HERNANDEZ CRNA
Provider Business Mailing Address
First Line : PO BOX 1226
Second Line :
City : ODESSA
State : TX
Zip : 79760-1226
Country : US
Telephone Number : 432-334-8088
Fax Number : 432-580-7202
Provider Business Practice Location Address
First Line : 520 E 6TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79761-4527
Country : US
Telephone Number : 432-334-8088
Fax Number : 432-580-7202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 07/08/2007

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Directions to “ DERRICK HERNANDEZ CRNA” Practice Location

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