Provider Demographics
NPI:1346318052
Name:HERNANDEZ, CAROLINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
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 760488
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-0488
Mailing Address - Country:US
Mailing Address - Phone:210-523-9933
Mailing Address - Fax:210-647-0242
Practice Address - Street 1:11212 STATE HIGHWAY 151
Practice Address - Street 2:MEDICAL PLAZA I, STE 190
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4498
Practice Address - Country:US
Practice Address - Phone:210-523-9933
Practice Address - Fax:210-647-0242
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7752207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164264701Medicaid
TX164264701Medicaid