Provider Demographics
NPI:1275629412
Name:HERNANDEZ, VICTORIA L (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:ATT: MEDICAL STAFF OFFICE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2315
Mailing Address - Country:US
Mailing Address - Phone:312-567-7924
Mailing Address - Fax:312-567-6189
Practice Address - Street 1:47 W POLK ST
Practice Address - Street 2:SUITE G1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2000
Practice Address - Country:US
Practice Address - Phone:312-922-3011
Practice Address - Fax:312-922-5860
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036066374208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics