1699828020 NPI number — DR. KAREN HERNANDEZ PH.D.

Table of content: DR. KAREN HERNANDEZ PH.D. (NPI 1699828020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699828020 NPI number — DR. KAREN HERNANDEZ PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699828020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12750 SW 2ND ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97005-2778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-803-9530
Provider Business Mailing Address Fax Number:
503-642-3179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12750 SW 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97005-2778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-803-9530
Provider Business Practice Location Address Fax Number:
503-642-3179
Provider Enumeration Date:
01/19/2007

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: 103T00000X , with the licence number:  1596 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 029142 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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