Provider Demographics
NPI:1689618985
Name:HERNANDEZ, ROSE (DO)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 E SONORAN TRL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-8236
Mailing Address - Country:US
Mailing Address - Phone:480-595-2389
Mailing Address - Fax:
Practice Address - Street 1:675 E 2100 S
Practice Address - Street 2:SUITE 390
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1887
Practice Address - Country:US
Practice Address - Phone:800-366-1884
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine