Healthcare Provider Details

I. General information

NPI: 1316833023
Provider Name (Legal Business Name): CARLOS EDUARDO HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

996 W 600 S
OREM UT
84058-6087
US

IV. Provider business mailing address

12760 S PARK AVE UNIT 520
RIVERTON UT
84065-3422
US

V. Phone/Fax

Practice location:
  • Phone: 801-427-4793
  • Fax:
Mailing address:
  • Phone: 801-210-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: