Provider Demographics
NPI:1710984406
Name:HERNANDEZ, CARLOS OMAR (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:OMAR
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4438 CENTERVIEW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228
Mailing Address - Country:US
Mailing Address - Phone:210-280-0040
Mailing Address - Fax:210-280-0060
Practice Address - Street 1:4438 CENTERVIEW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228
Practice Address - Country:US
Practice Address - Phone:210-280-0040
Practice Address - Fax:210-280-0060
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4704207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP08432K81Medicaid
TX8815B1OtherWELLMED MEDICARE
TX101829303OtherWELLMED MEDICAID
TX8815B1OtherWELLMED MEDICARE