Provider Demographics
NPI:1407615057
Name:HERNANDEZ, RICHARD (NP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:RICH
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4326 N CANE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-7430
Mailing Address - Country:US
Mailing Address - Phone:928-897-5978
Mailing Address - Fax:
Practice Address - Street 1:4326 N CANE RANCH RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-7430
Practice Address - Country:US
Practice Address - Phone:928-897-5978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program