Individual
MARIO AUGUSTO HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18509 STATESVILLE RD STE B1, CORNELIUS, NC 28031-5703
(704) 237-3421
Mailing address
18509 STATESVILLE RD STE B1, CORNELIUS, NC 28031-5703
(704) 237-3421
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101244562
VA
207Q00000X
Family Medicine Physician
16949
PR
207Q00000X
Family Medicine Physician
Primary
2010-00567
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5915310
—
NC
05
—
7100062480
—
KY
Enumeration date
12/21/2007
Last updated
12/06/2011
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