MEDICARE: CARLA CRISTINA HERNANDEZ DMD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	41698	TX

General Provider Information

NPI Number	:	1376434605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA CRISTINA HERNANDEZ DMD

Provider Business Mailing Address
First Line	:	3647 E EVANS RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-1717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3647 E EVANS RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-1717
Country	:	US
Telephone Number	:	210-594-0640
Fax Number	:

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

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	07/14/2025

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