Provider Demographics
NPI:1881824159
Name:HERNANDEZ SOLANO, OMAR D (IDMT)
Entity type:Individual
Prefix:MR
First Name:OMAR
Middle Name:D
Last Name:HERNANDEZ SOLANO
Suffix:
Gender:M
Credentials:IDMT
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Mailing Address - Street 1:90 HOPE DR BLDG 6000
Mailing Address - Street 2:366 AMDS/SGPF
Mailing Address - City:MOUNTAIN HOME A F B
Mailing Address - State:ID
Mailing Address - Zip Code:83648-1062
Mailing Address - Country:US
Mailing Address - Phone:208-828-7401
Mailing Address - Fax:208-828-1498
Practice Address - Street 1:90 HOPE DR BLDG 6000
Practice Address - Street 2:366 AMDS/SGPF
Practice Address - City:MOUNTAIN HOME A F B
Practice Address - State:ID
Practice Address - Zip Code:83648-1062
Practice Address - Country:US
Practice Address - Phone:208-828-7401
Practice Address - Fax:208-828-1498
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians