Provider Demographics
NPI:1104462860
Name:HERNANDEZ, ADRIAN E (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:E
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N VAN DORN ST APT 1223
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1608
Mailing Address - Country:US
Mailing Address - Phone:443-404-8256
Mailing Address - Fax:
Practice Address - Street 1:2500 N VAN DORN ST APT 1223
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1608
Practice Address - Country:US
Practice Address - Phone:443-404-8256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100001198133V00000X
MDDX4743133V00000X
86000955133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered