Provider Demographics
NPI:1649004771
Name:PEDICAREPM PLLC
Entity type:Organization
Organization Name:PEDICAREPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSN APRN CPNP-PC
Authorized Official - Phone:915-227-8702
Mailing Address - Street 1:9001 CASHEW DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-1865
Mailing Address - Country:US
Mailing Address - Phone:915-227-8702
Mailing Address - Fax:
Practice Address - Street 1:9001 CASHEW DR STE 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-1865
Practice Address - Country:US
Practice Address - Phone:915-227-8702
Practice Address - Fax:915-207-7394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty