Provider Demographics
NPI:1386655058
Name:HERNANDEZ MORENO, CARLOS E (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:E
Last Name:HERNANDEZ MORENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1310
Mailing Address - Street 2:PO BOX 1310
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501
Mailing Address - Country:UM
Mailing Address - Phone:787-895-0045
Mailing Address - Fax:787-817-2571
Practice Address - Street 1:14 GREAT PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:ARAPAHOE
Practice Address - State:WY
Practice Address - Zip Code:82510-0014
Practice Address - Country:US
Practice Address - Phone:307-856-9281
Practice Address - Fax:307-463-4489
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR7536208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29594OtherT-SSS