1922581396 NPI number — MRS. TAMARA ANN HERNANDEZ CPC-I, MSCRMHC, BS

Table of content: MRS. TAMARA ANN HERNANDEZ CPC-I, MSCRMHC, BS (NPI 1922581396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922581396 NPI number — MRS. TAMARA ANN HERNANDEZ CPC-I, MSCRMHC, BS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
TAMARA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPC-I, MSCRMHC, BS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULLIS
Provider Other First Name:
TAMARA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPC-I, MSCRMHC, ASDI
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922581396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3960 E PATRICK LN STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89120-4902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-810-9927
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 JUNIPER RIDGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89015-6902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-809-7748
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2018

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1922581396 . This is a "REGISTERED BEHAVIOR TECHNICIAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1922581396 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".