MEDICARE: DR. CARMELO ABEL HERNANDEZ M.D.

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	207V00000X	Obstetrics & Gynecology Physician	200100889	NC

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437154382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMELO ABEL HERNANDEZ M.D.

Provider Business Mailing Address
First Line	:	106 BLANCA AVE
Second Line	:
City	:	ALAMOSA
State	:	CO
Zip	:	81101-2340
Country	:	US
Telephone Number	:	719-587-1417
Fax Number	:	719-587-6324

Provider Business Practice Location Address
First Line	:	106 BLANCA AVE
Second Line	:
City	:	ALAMOSA
State	:	CO
Zip	:	81101-2340
Country	:	US
Telephone Number	:	719-589-8028
Fax Number	:	719-589-8086

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	05/05/2021

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