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General NPI Number Information
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NPI Number | 1982918314
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE CARE, PLLC
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 18509 STATESVILLE RD STE B1
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City | CORNELIUS
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State | NC
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Zip | 28031-5703
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Country | US
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Telephone | 704-359-7426
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Fax |
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Provider Business Mailing Address
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Address Line | 18509 STATESVILLE RD STE B1
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City | CORNELIUS
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State | NC
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Zip | 28031-5703
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Country | US
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Telephone | 704-359-7426
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. MARIO AUGUSTO HERNANDEZ
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Credential | MD
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Telephone | 704-359-7426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 201000567
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License Number State | NC
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