Provider Demographics
NPI:1215194238
Name:HERNANDEZ, RITA (AAS)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2285
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004
Mailing Address - Country:US
Mailing Address - Phone:575-882-5101
Mailing Address - Fax:575-882-6127
Practice Address - Street 1:820 HWY 478
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021
Practice Address - Country:US
Practice Address - Phone:575-882-5101
Practice Address - Fax:575-882-6127
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist