Provider Demographics
NPI:1962686139
Name:HERNANDEZ, MARIA ELISA (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELISA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 N VIRGINIA ST STE F
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5311
Mailing Address - Country:US
Mailing Address - Phone:915-544-3500
Mailing Address - Fax:915-544-3503
Practice Address - Street 1:1514 ZARAGOZA STE B-3
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-855-4400
Practice Address - Fax:915-855-4404
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05441363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXY0155412OtherDPS