Provider Demographics
NPI:1700145497
Name:HERNANDEZ, ASTRID
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4532
Mailing Address - Country:US
Mailing Address - Phone:202-386-8539
Mailing Address - Fax:
Practice Address - Street 1:1425 T ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3969
Practice Address - Country:US
Practice Address - Phone:202-286-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2023-11-02
Deactivation Date:2023-02-01
Deactivation Code:
Reactivation Date:2023-10-31
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant