Provider Demographics
NPI:1477682227
Name:ANTHONY C HERNANDEZ M D INC
Entity Type:Organization
Organization Name:ANTHONY C HERNANDEZ M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:CADIENTE
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-848-1515
Mailing Address - Street 1:1824 DILLINGHAM BLVD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4019
Mailing Address - Country:US
Mailing Address - Phone:808-848-1515
Mailing Address - Fax:808-848-1515
Practice Address - Street 1:1824 DILLINGHAM BLVD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4019
Practice Address - Country:US
Practice Address - Phone:808-848-1515
Practice Address - Fax:808-848-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5996261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB3303-1OtherHMSA PROVIDER NUMBER
HI029644-01Medicaid
HIB3303-1OtherHMSA PROVIDER NUMBER
GUD36333Medicare UPIN