Provider Demographics
NPI:1598934325
Name:RAFAELA G HERNANDEZ MD CHTD
Entity Type:Organization
Organization Name:RAFAELA G HERNANDEZ MD CHTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAELA
Authorized Official - Middle Name:GUTIERREZ
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-337-8400
Mailing Address - Street 1:236 W 6TH ST
Mailing Address - Street 2:#303
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4517
Mailing Address - Country:US
Mailing Address - Phone:775-337-8400
Mailing Address - Fax:775-337-8407
Practice Address - Street 1:236 W 6TH ST
Practice Address - Street 2:#303
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4517
Practice Address - Country:US
Practice Address - Phone:775-337-8400
Practice Address - Fax:775-337-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504022Medicaid
39178Medicare PIN
I05147Medicare UPIN