1104284579 NPI number — MS. IMELDA VERONICA HERNANDEZ CASE MANAGEMENT

Table of content: MS. JHAQUISHA DENISE MITCHELL (NPI 1689386856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104284579 NPI number — MS. IMELDA VERONICA HERNANDEZ CASE MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
IMELDA
Provider Middle Name:
VERONICA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CASE MANAGEMENT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAFOLLA
Provider Other First Name:
IMELDA
Provider Other Middle Name:
VERONICA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CASE MANAGEMENT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104284579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 W MERIDA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESLACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78599-3855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-463-8360
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 E JACKSON ST STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-6849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-778-6886
Provider Business Practice Location Address Fax Number:
210-618-0324
Provider Enumeration Date:
02/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  58465 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 58465 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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