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General NPI Number Information
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NPI Number | 1932271996
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Entity Type | Organization
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Legal Business Name | MARTIN JAY HERNANDEZ MD PC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 711 E MISSOURI AVE SUITE 190
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City | PHOENIX
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State | AZ
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Zip | 85014-2841
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Country | US
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Telephone | 623-936-3223
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Fax | 623-936-4554
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Provider Business Mailing Address
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Address Line | 711 E MISSOURI AVE SUITE 190
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City | PHOENIX
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State | AZ
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Zip | 85014-2841
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Country | US
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Telephone | 623-936-3223
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Fax | 623-936-4554
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Authorized Official
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Title or Position | OWNER
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Name | MARTIN JAY HERNANDEZ
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Credential | MD
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Telephone | 623-936-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31880
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License Number State | AZ
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