Provider Demographics
NPI:1275240343
Name:HERNANDEZ, SALVADOR R JR
Entity Type:Individual
Prefix:MR
First Name:SALVADOR
Middle Name:R
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 PIONEER MESA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-8804
Mailing Address - Country:US
Mailing Address - Phone:956-310-2967
Mailing Address - Fax:
Practice Address - Street 1:5802 PIONEER MESA DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-8804
Practice Address - Country:US
Practice Address - Phone:956-310-2967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20221898066246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92-0363466OtherMOBILE LAB SERVICE