Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | MD00047205 | WA |
NPI | 1760516462 |
---|---|
Provider Name | Dr. Joel D Hernandez |
First Address | Spokane, WA 99201-2202 |
Second Address | Spokane, WA 99204-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
807680300 | IDAHO MEDICAID (01) | WA |
8480683 | WA MEDICAID (01) | WA |
BH8401488 | DEA (01) | CA |
G8864785 | MEDICARE PTAN (01) | WA |
GAB32999 | MEDICARE GROUP (01) | WA |