Basic Information
| Provider Information | |||||||||
| NPI: | 1871908178 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ HERNANDEZ | ||||||||
| FirstName: | ALEJANDRO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 SAN ALEJANDRO | ||||||||
| Address2: | |||||||||
| City: | MISSION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785727281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122871532 | ||||||||
| FaxNumber: | 9562157459 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 E TORONTO AVE | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785031209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566876155 | ||||||||
| FaxNumber: | 9566180451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2014 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R0246 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | BP10051015 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207PE0005X | R0246 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine |
ID Information
| ID | Type | State | Issuer | Description | H08HW01401 | 01 | TX | BCBS | OTHER | 3740813-10 | 05 | TX | MEDICAID |