Healthcare Provider Details

I. General information

NPI: 1366717449
Provider Name (Legal Business Name): MARIA SALVADORA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 HUGHES AVE
FAIRBANKS AK
99701-7539
US

IV. Provider business mailing address

605 HUGHES AVE
FAIRBANKS AK
99701-7539
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-1648
  • Fax: 907-459-4849
Mailing address:
  • Phone: 907-452-1648
  • Fax: 907-456-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number5345
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: