MEDICARE: MARIA ELISA HERNANDEZ MPAS, PA-C

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	363A00000X	Physician Assistant	PA05441	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y0155412	OTHER	TX	DPS

General Provider Information

NPI Number	:	1962686139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ELISA HERNANDEZ MPAS, PA-C

Provider Business Mailing Address
First Line	:	616 N VIRGINIA ST STE F
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-5311
Country	:	US
Telephone Number	:	915-544-3500
Fax Number	:	915-544-3503

Provider Business Practice Location Address
First Line	:	1514 ZARAGOZA STE B-3
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936
Country	:	US
Telephone Number	:	915-855-4400
Fax Number	:	915-855-4404

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

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	12/24/2007

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