Healthcare Provider Details

I. General information

NPI: 1457328221
Provider Name (Legal Business Name): RICHARD A. HERNANDEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICHARD HERNANDEZ

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE # C70
PROVIDENCE RI
02906-2853
US

IV. Provider business mailing address

PO BOX 16149
RUMFORD RI
02916-0697
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-4545
  • Fax: 401-793-7866
Mailing address:
  • Phone: 401-453-9625
  • Fax: 401-435-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00382
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA00382
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: