Healthcare Provider Details

I. General information

NPI: 1205330511
Provider Name (Legal Business Name): DOROTHY HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 W UNIVERSITY AVE STE 107
FLAGSTAFF AZ
86001-2995
US

IV. Provider business mailing address

1016 W UNIVERSITY AVE STE 107
FLAGSTAFF AZ
86001-2995
US

V. Phone/Fax

Practice location:
  • Phone: 928-779-4404
  • Fax: 928-226-0969
Mailing address:
  • Phone: 928-779-4404
  • Fax: 928-226-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: