Basic Information
| Provider Information | |||||||||
| NPI: | 1467492314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ-RIOS | ||||||||
| FirstName: | PABLO | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 CLAY EDWARDS DR | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641163237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162410928 | ||||||||
| FaxNumber: | 8169368118 | ||||||||
| Practice Location | |||||||||
| Address1: | 2750 CLAY EDWARDS DR | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641163237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162410928 | ||||||||
| FaxNumber: | 8169368118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 2006008749 | MO | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZC0500X | 054512 | GA | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZC0500X | 04-31892 | KS | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZC0500X | 2006008749 | MO | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZP0102X | 054512 | GA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 04-31892 | KS | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 04-31892 | 01 | KS | STATE MEDICAL LICENSE | OTHER | 2006008749 | 01 | MO | STATE MEDICAL LICENSE | OTHER | 054512 | 01 | GA | STATE MEDICAL LICENSE | OTHER |