Healthcare Provider Details

I. General information

NPI: 1972518660
Provider Name (Legal Business Name): VERONICA H. HERNANDEZ LMT 2962
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 ROSE LN
LAS CRUCES NM
88005-1456
US

IV. Provider business mailing address

2032 ROSE LN
LAS CRUCES NM
88005-1456
US

V. Phone/Fax

Practice location:
  • Phone: 575-649-4535
  • Fax:
Mailing address:
  • Phone: 575-649-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberNM2962
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: