Healthcare Provider Details

I. General information

NPI: 1235303876
Provider Name (Legal Business Name): DANIEL G. HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 2ND ST SW SUITE 5314
WASHINGTON DC
20593
US

IV. Provider business mailing address

2100 2ND ST SW SUITE 5314
WASHINGTON DC
20593
US

V. Phone/Fax

Practice location:
  • Phone: 361-939-6206
  • Fax: 361-939-6206
Mailing address:
  • Phone: 361-939-6206
  • Fax: 361-939-6206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: