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General NPI Number Information
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NPI Number | 1568687176
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Entity Type | Organization
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Legal Business Name | DR. JOHN G. HERNANDEZ & ASSOC. INC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 79 HIGHLAND AVE SUITE 308
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City | SALEM
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State | MA
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Zip | 01970-2711
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Country | US
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Telephone | 978-745-0151
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Fax | 978-745-0203
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Provider Business Mailing Address
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Address Line | 79 HIGHLAND AVE SUITE 308
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City | SALEM
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State | MA
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Zip | 01970-2711
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Country | US
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Telephone | 978-745-0151
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Fax | 978-745-0203
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Authorized Official
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Title or Position | OWNER OF BUSINESS
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Name | DR. JOHN G. HERNANDEZ
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Credential | M.D.
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Telephone | 978-745-0151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 56700
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License Number State | MA
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