Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | 60917702 | WA |
Y | 207RA0201X | Internist - Allergy & Immunology | D0076598 | MD |
NPI | 1518229855 |
---|---|
Provider Name | Dr. Camellia Louisa Hernandez |
First Address | Fairfax, VA 22031-4857 |
Second Address | Tacoma, WA 98431-0004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2012 |
Last Update Date | 04/03/2019 |