Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OP60384409 | WA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | OP60384409 | WA |
NPI | 1497918858 |
---|---|
Provider Name | Tania Guadalupe Hernandez |
First Address | Monroe, WA 98272-2170 |
Second Address | Monroe, WA 98272-4127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 10/10/2021 |