Provider Demographics
NPI:1043222987
Name:CAROLINE HERNANDEZ, MD,PA
Entity Type:Organization
Organization Name:CAROLINE HERNANDEZ, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-674-2233
Mailing Address - Street 1:1739 SW LOOP 410
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-1668
Mailing Address - Country:US
Mailing Address - Phone:210-674-2233
Mailing Address - Fax:210-674-4553
Practice Address - Street 1:1739 SW LOOP 410
Practice Address - Street 2:SUITE 402
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1668
Practice Address - Country:US
Practice Address - Phone:210-674-2233
Practice Address - Fax:210-674-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00425WMedicare PIN