MEDICARE: MS. IMELDA VERONICA HERNANDEZ CASE MANAGEMENT

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	171M00000X	Case Manager/Care Coordinator	58465	TX
2	251B00000X	Case Management Agency	58465	TX

General Provider Information

NPI Number	:	1104284579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IMELDA VERONICA HERNANDEZ CASE MANAGEMENT

Provider Business Mailing Address
First Line	:	319 W MERIDA ST
Second Line	:
City	:	WESLACO
State	:	TX
Zip	:	78599-3855
Country	:	US
Telephone Number	:	956-463-8360
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 E JACKSON ST STE 4
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-6849
Country	:	US
Telephone Number	:	956-778-6886
Fax Number	:	210-618-0324

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

Provider Enumeration Date	:	02/01/2016
Last Update Date	:	03/01/2023

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