MEDICARE: DR. CARLOS HERNANDEZ-FERNANDEZ CSA

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	174400000X	Specialist

General Provider Information

NPI Number	:	1992062988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS HERNANDEZ-FERNANDEZ CSA

Provider Business Mailing Address
First Line	:	3559 S NEWLAND ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80235-2620
Country	:	US
Telephone Number	:	720-468-2252
Fax Number	:

Provider Business Practice Location Address
First Line	:	3559 S NEWLAND ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80235-2620
Country	:	US
Telephone Number	:	720-468-2252
Fax Number	:

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

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	06/11/2013

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