MEDICARE: DORIS 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	171M00000X	Case Manager/Care Coordinator		OR

General Provider Information

NPI Number	:	1811034358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS HERNANDEZ

Provider Business Mailing Address
First Line	:	PO BOX 20494
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97307-0494
Country	:	US
Telephone Number	:	503-371-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	1179 7TH ST NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304
Country	:	US
Telephone Number	:	503-371-9123
Fax Number	:

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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Directions to “ DORIS HERNANDEZ ” Practice Location

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