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General NPI Number Information
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NPI Number | 1386655058
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Entity Type | Individual
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Provider Name | CARLOS E HERNANDEZ MORENO MD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 14 GREAT PLAINS ROAD
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City | ARAPAHOE
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State | WY
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Zip | 82510-0014
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Country | US
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Telephone | 307-856-9281
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Fax | 307-463-4489
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Provider Business Mailing Address
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Address Line | PO BOX 1310 PO BOX 1310
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City | RIVERTON
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State | WY
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Zip | 82501
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Country | UM
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Telephone | 787-895-0045
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Fax | 787-817-2571
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 7536
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License Number State | PR
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