MEDICARE: ALEXANDRA RODRIGUEZ HERNANDEZ

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	208000000X	Pediatrics Physician	304312	NY
2	2080H0002X	Pediatric Hospice and Palliative Medicine Physician	01094059A	IN
3	390200000X	Student in an Organized Health Care Education/Training Program
4	2080P0207X	Pediatric Hematology & Oncology Physician	01094059A	IN

General Provider Information

NPI Number	:	1467986133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA RODRIGUEZ HERNANDEZ

Provider Business Mailing Address
First Line	:	PO BOX 778912
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-8912
Country	:	US
Telephone Number	:	317-777-6435
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 S DEBORAH DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-4228
Country	:	US
Telephone Number	:	812-353-2660
Fax Number	:

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

Provider Enumeration Date	:	04/19/2017
Last Update Date	:	03/27/2025

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