Individual
MICHAEL HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
121 S BYRON AVE, SHELLEY, ID 83274-1209
(208) 881-3072
Mailing address
121 S BYRON AVE, SHELLEY, ID 83274-1209
(208) 881-3072
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
11/23/2022
Last updated
11/23/2022
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