MEDICARE: DR. SANDRA LUZ 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	MD00040400	WA
2	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	MD00040400	WA

General Provider Information

NPI Number	:	1740380377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA LUZ HERNANDEZ M.D.

Provider Business Mailing Address
First Line	:	2000B TRANSMOUNTAIN RD STE 200
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3600
Country	:	US
Telephone Number	:	915-541-1144
Fax Number	:	915-541-1170

Provider Business Practice Location Address
First Line	:	2000B TRANSMOUNTAIN RD STE 200
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3600
Country	:	US
Telephone Number	:	915-541-1144
Fax Number	:	915-541-1170

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

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	03/15/2021

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