Healthcare Provider Details

I. General information

NPI: 1992624738
Provider Name (Legal Business Name): NEIDA HERNANDEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W 84TH AVE STE 116
THORNTON CO
80260-4808
US

IV. Provider business mailing address

5128 BUCKWHEAT RD
BRIGHTON CO
80640-9670
US

V. Phone/Fax

Practice location:
  • Phone: 720-329-5627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: