Provider Demographics
NPI:1639967235
Name:HERNANDEZ, CARLOS ROBERTO (CHW)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ROBERTO
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ANGELINA BLVD
Mailing Address - Street 2:
Mailing Address - City:CHAPARRAL
Mailing Address - State:NM
Mailing Address - Zip Code:88081-7558
Mailing Address - Country:US
Mailing Address - Phone:575-824-8100
Mailing Address - Fax:505-443-8330
Practice Address - Street 1:204 ANGELINA BLVD
Practice Address - Street 2:
Practice Address - City:CHAPARRAL
Practice Address - State:NM
Practice Address - Zip Code:88081-7558
Practice Address - Country:US
Practice Address - Phone:575-824-8100
Practice Address - Fax:505-443-8330
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker