Provider Demographics
NPI:1760132658
Name:HERNANDEZ, CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15758 S BELL RD # 11
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8400
Mailing Address - Country:US
Mailing Address - Phone:708-275-8893
Mailing Address - Fax:708-301-7096
Practice Address - Street 1:15758 S BELL RD # 11
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8400
Practice Address - Country:US
Practice Address - Phone:708-275-8893
Practice Address - Fax:708-301-7096
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician