Provider Demographics
NPI:1629071907
Name:HERNANDEZ, JULIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:6525 W SACK DR
Practice Address - Street 2:STE 307
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7107
Practice Address - Country:US
Practice Address - Phone:623-825-5300
Practice Address - Fax:623-825-0938
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2018-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ22572207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ120563Medicare PIN
AZB64481Medicare UPIN
AZZ20409Medicare ID - Type Unspecified