=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922446418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID S HERNANDEZ, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2013
-----------------------------------------------------
Last Update Date | 06/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1619 COMMON ST STE 902
-----------------------------------------------------
City | NEW BRAUNFELS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78130-3461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-214-0104
-----------------------------------------------------
Fax | 830-358-7371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1619 COMMON ST STE 902
-----------------------------------------------------
City | NEW BRAUNFELS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78130-3461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-214-0104
-----------------------------------------------------
Fax | 830-358-7371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID S HERNANDEZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 830-214-0104
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | M4148
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------