Healthcare Provider Details

I. General information

NPI: 1356436539
Provider Name (Legal Business Name): CESAR J. HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: C JAVIER HERNANDEZ MD

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LEAD AVE SE STE 4
ALBUQUERQUE NM
87106-5214
US

IV. Provider business mailing address

1010 LEAD AVE SE STE 4
ALBUQUERQUE NM
87106-5214
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-5902
  • Fax: 505-242-6313
Mailing address:
  • Phone: 505-842-5902
  • Fax: 505-242-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number20020272
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: