MEDICARE: GUILLERMO E HERNANDEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	507056	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00184690	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	84155U	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003887795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUILLERMO E HERNANDEZ MD

Provider Business Mailing Address
First Line	:	8511 MCPHERSON ROAD
Second Line	:	SUITE 105, PMB 233
City	:	LAREDO
State	:	TX
Zip	:	78045
Country	:	US
Telephone Number	:	956-523-2619
Fax Number	:

Provider Business Practice Location Address
First Line	:	10700 MCPHERSON AVE
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-6268
Country	:	US
Telephone Number	:	956-523-2619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	02/02/2012

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Directions to “ GUILLERMO E HERNANDEZ MD” Practice Location

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