=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598934325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAFAELA G HERNANDEZ MD CHTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2008
-----------------------------------------------------
Last Update Date | 05/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 236 W 6TH ST #303
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89503-4517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-337-8400
-----------------------------------------------------
Fax | 775-337-8407
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 236 W 6TH ST #303
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89503-4517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-337-8400
-----------------------------------------------------
Fax | 775-337-8407
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RAFAELA GUTIERREZ HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 775-337-8400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 10759
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------