Healthcare Provider Details

I. General information

NPI: 1720395304
Provider Name (Legal Business Name): HUGO HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 S OGDEN ST
CENTENNIAL CO
80121-2562
US

IV. Provider business mailing address

6625 S OGDEN ST
CENTENNIAL CO
80121-2562
US

V. Phone/Fax

Practice location:
  • Phone: 720-231-1566
  • Fax:
Mailing address:
  • Phone: 720-231-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: