# MARIO AUGUSTO HERNANDEZ

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1700060092
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0101244562 | VA | — |
| 207Q00000X | Family Medicine Physician | 16949 | PR | — |
| 207Q00000X | Family Medicine Physician | 2010-00567 | NC | Yes |

## Other

- **Enumeration date:** 12/21/2007
- **Last updated:** 12/06/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5915310 | — | NC |
| 05 | — | 7100062480 | — | KY |