1962686139 NPI number — MARIA ELISA HERNANDEZ MPAS, PA-C

Table of content: MARIA ELISA HERNANDEZ MPAS, PA-C (NPI 1962686139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962686139 NPI number — MARIA ELISA HERNANDEZ MPAS, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
MARIA
Provider Middle Name:
ELISA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPAS, PA-C
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:
1962686139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1514 ZARAGOZA STE B-3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-855-4400
Provider Business Practice Location Address Fax Number:
915-855-4404
Provider Enumeration Date:
12/24/2007

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: 363A00000X , with the licence number:  PA05441 , 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)

  • Identifier: Y0155412 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".