Healthcare Provider Details

I. General information

NPI: 1689739161
Provider Name (Legal Business Name): CELESTINE Q HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 03/07/2023
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 ERRECART BLVD STE 103
ELKO NV
89801-8336
US

IV. Provider business mailing address

1995 ERRECART BLVD STE 103
ELKO NV
89801-8336
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-3111
  • Fax: 775-778-6728
Mailing address:
  • Phone: 775-738-3111
  • Fax: 775-778-6728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8882
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: