Provider Demographics
NPI:1295372829
Name:HERNANDEZ, GIOVANNI JR
Entity Type:Individual
Prefix:MR
First Name:GIOVANNI
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GIOVANNI
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1930 JOYFUL
Mailing Address - Street 2:ST
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-7352
Mailing Address - Country:US
Mailing Address - Phone:702-524-5235
Mailing Address - Fax:
Practice Address - Street 1:1930 JOYFUL
Practice Address - Street 2:ST
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-7352
Practice Address - Country:US
Practice Address - Phone:702-524-5235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty