Provider Demographics
NPI:1023252814
Name:HERNANDEZ UMANA, JUAN CARLOS (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:HERNANDEZ UMANA
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 1:1035 NIDER BLVD # 100
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459-8701
Mailing Address - Country:US
Mailing Address - Phone:757-953-8351
Mailing Address - Fax:
Practice Address - Street 1:3905 SANDIFUR PARKWAY
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-942-3170
Practice Address - Fax:509-543-9795
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101270745207Q00000X
TXP8590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX395924YKPWMedicare PIN