Provider Demographics
NPI:1174745863
Name:HERNANDEZ, ARACELI (EDS)
Entity type:Individual
Prefix:MS
First Name:ARACELI
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 W LAS LOMITAS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3649
Mailing Address - Country:US
Mailing Address - Phone:520-292-1168
Mailing Address - Fax:
Practice Address - Street 1:1100 W FRESNO ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2711
Practice Address - Country:US
Practice Address - Phone:520-225-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ132962Medicare ID - Type Unspecified