Basic Information
| Provider Information | |||||||||
| NPI: | 1962686139 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ELISA | ||||||||
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| Credential: | MPAS, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 616 N VIRGINIA ST STE F | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799025311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155443500 | ||||||||
| FaxNumber: | 9155443503 | ||||||||
| Practice Location | |||||||||
| Address1: | 1514 ZARAGOZA STE B-3 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158554400 | ||||||||
| FaxNumber: | 9158554404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2007 | ||||||||
| LastUpdateDate: | 12/24/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA05441 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | Y0155412 | 01 | TX | DPS | OTHER |