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General NPI Number Information
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NPI Number | 1487088852
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Entity Type | Individual
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Provider Name | LUIS FERNANDO HERNANDEZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 128 MARKET ST
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City | ALAMOSA
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State | CO
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Zip | 81101-2290
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Country | US
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Telephone | 719-589-5161
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Fax |
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Provider Business Mailing Address
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Address Line | 211 EDISON AVE
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City | ALAMOSA
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State | CO
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Zip | 81101-2531
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Country | US
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Telephone | 208-316-6272
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0003766
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License Number State | CO
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