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NPI Code Detail

MEDICARE: JOSE EBERARDO HERNANDEZ

MEDICARE: JOSE EBERARDO 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
1101YM0800XMental Health CounselorOR

General Provider Information

NPI Number : 1558238881
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE EBERARDO HERNANDEZ
Provider Business Mailing Address
First Line : PO BOX 255
Second Line :
City : MERRILL
State : OR
Zip : 97633-0255
Country : US
Telephone Number : 541-891-8569
Fax Number :
Provider Business Practice Location Address
First Line : 1515 OLD FORT RD
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-9374
Country : US
Telephone Number : 541-273-2022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2025
Last Update Date : 10/21/2025

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Directions to “ JOSE EBERARDO HERNANDEZ ” Practice Location

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