Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD-43064 | IA |
N | 207VX0000X | Obstetrician | MD-43064 | IA |
NPI | 1891960738 |
---|---|
Provider Name | Maria Dolores Hernandez |
First Address | Carroll, IA 51401-3047 |
Second Address | Phoenix, AZ 85008-4973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 28/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
81101 | TRAINING PERMIT (01) |