Provider Demographics
NPI:1508336637
Name:HERNANDEZ, VICTOR ORLANDO (CSFA)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:ORLANDO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1801 BELLE VIEW BLVD APT C2
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-6728
Mailing Address - Country:US
Mailing Address - Phone:305-206-8331
Mailing Address - Fax:
Practice Address - Street 1:125 POTOMAC PSGE UNIT 200
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1580
Practice Address - Country:US
Practice Address - Phone:305-206-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-02
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
185997246ZC0007X
111590246ZS0410X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
185997OtherNATIONAL BOARD OF SURIGCAL TECHNOLOGIST AND SURGICAL ASSISTING (NBSTSA)