Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036-120314 | IL |
N | 2080N0001X | Neonatal-Perinatal Doctor | A105435 | CA |
NPI | 1104074749 |
---|---|
Provider Name | Hernan Sierra Fernandez |
First Address | Chicago, IL 60602-4768 |
Second Address | Chicago, IL 60612-4325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2008 |
Last Update Date | 01/05/2020 |