Individual
CARLOS HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
420 GUNBY AVE, BASTROP, LA 71220-4406
(318) 281-3432
Mailing address
420 GUNBY AVE, BASTROP, LA 71220-4406
(318) 281-3432
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
A10630RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1625892
—
LA
Enumeration date
07/10/2006
Last updated
03/07/2023
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