Individual
ALICIA ANN HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4515 COORS BLVD NW, ALBUQUERQUE, NM 87120-3699
(505) 596-2200
Mailing address
2815 GUNNISON DR APT 201, COLUMBUS, OH 43228-8985
(419) 789-1879
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2024-0005
NM
363AM0700X
Medical Physician Assistant
PA2024-0005
NM
Other
Enumeration date
01/31/2024
Last updated
03/12/2024
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