Provider Demographics
NPI:1093998379
Name:CHRISTINE K HERNANDEZ MD PA & ASSOCIATES
Entity Type:Organization
Organization Name:CHRISTINE K HERNANDEZ MD PA & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-595-1812
Mailing Address - Street 1:1724 WESTON BRENT LANE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-1424
Mailing Address - Country:US
Mailing Address - Phone:915-595-1812
Mailing Address - Fax:915-595-8889
Practice Address - Street 1:1724 WESTON BRENT LANE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-1424
Practice Address - Country:US
Practice Address - Phone:915-595-1812
Practice Address - Fax:915-595-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TXG6841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130885002Medicaid
C16860Medicare UPIN
TX130885002Medicaid
00676NMedicare PIN