Provider Demographics
NPI:1356436539
Name:HERNANDEZ, CESAR J (MD)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:J
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C
Other - Middle Name:JAVIER
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1010 LEAD AVE SE STE 4
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-5214
Mailing Address - Country:US
Mailing Address - Phone:505-842-5902
Mailing Address - Fax:505-242-6313
Practice Address - Street 1:1010 LEAD AVE SE STE 4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-5214
Practice Address - Country:US
Practice Address - Phone:505-842-5902
Practice Address - Fax:505-242-6313
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020272207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1063439800OtherNPI GROUP
NMOONM001009OtherBCBS
NM200521050OtherMEDICARE GROUP
NM95822739OtherMEDICAID GROUP
NM12134805Medicaid
NM346706103Medicare PIN
NMOONM001009OtherBCBS