Individual
MATTHEW HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSW
Contact information
Practice address
4011 BARBARA LOOP SE STE 207, RIO RANCHO, NM 87124-1041
(505) 865-3350
(505) 865-4739
Mailing address
PO BOX 518, LOS LUNAS, NM 87031-0518
(505) 865-3350
(505) 865-4739
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44842
—
NM
Enumeration date
09/03/2010
Last updated
09/03/2010
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