Provider Demographics
NPI:1457622318
Name:HERNANDEZ, DAVID (RD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PORTER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8423
Mailing Address - Country:US
Mailing Address - Phone:802-388-5620
Mailing Address - Fax:802-388-8870
Practice Address - Street 1:37 PORTER DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8428
Practice Address - Country:US
Practice Address - Phone:802-388-4705
Practice Address - Fax:802-388-5696
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered