Healthcare Provider Details

I. General information

NPI: 1508336637
Provider Name (Legal Business Name): VICTOR ORLANDO HERNANDEZ CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2018
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 POTOMAC PSGE UNIT 200
OXON HILL MD
20745-1580
US

IV. Provider business mailing address

1801 BELLE VIEW BLVD APT C2
ALEXANDRIA VA
22307-6728
US

V. Phone/Fax

Practice location:
  • Phone: 305-206-8331
  • Fax:
Mailing address:
  • Phone: 305-206-8331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number185997
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number111590
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: