Provider Demographics
NPI:1013768654
Name:HERNANDEZ, JORGE ALEJANDRO (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ALEJANDRO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1401 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1259
Mailing Address - Country:US
Mailing Address - Phone:773-229-1414
Mailing Address - Fax:
Practice Address - Street 1:1401 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1259
Practice Address - Country:US
Practice Address - Phone:773-229-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-07-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant