Provider Demographics
NPI:1902419690
Name:HERNANDEZ, OSCAR F
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:F
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7642 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-1127
Mailing Address - Country:US
Mailing Address - Phone:520-790-6882
Mailing Address - Fax:520-495-4343
Practice Address - Street 1:7642 E 38TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-1127
Practice Address - Country:US
Practice Address - Phone:520-790-6882
Practice Address - Fax:520-495-4343
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL11097H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility