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Individual

JESUS FERNANDO HERNANDEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
803 N SALK DR, CASA GRANDE, AZ 85222-5447
(520) 836-6682
(520) 836-6703
Mailing address
PO BOX 61773, PHOENIX, AZ 85082-1773
(602) 682-6701
(602) 240-6177

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
29091
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
632390
AZ
01
WCSKQ
SUN HEALTH GRP#
AZ
Enumeration date
01/05/2006
Last updated
11/01/2007
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