Healthcare Provider Details

I. General information

NPI: 1689839656
Provider Name (Legal Business Name): RYAN JAMES HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41-024 KAULU ST
WAIMANALO HI
96795-1612
US

IV. Provider business mailing address

41-024 KAULU ST
WAIMANALO HI
96795-1612
US

V. Phone/Fax

Practice location:
  • Phone: 210-691-0281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD-16628
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: