Provider Demographics
NPI:1063603926
Name:LOIDA M HERNANDEZ MD PROF CORP
Entity type:Organization
Organization Name:LOIDA M HERNANDEZ MD PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOIDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-876-1000
Mailing Address - Street 1:PO BOX 50067
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0067
Mailing Address - Country:US
Mailing Address - Phone:702-876-1000
Mailing Address - Fax:702-876-0061
Practice Address - Street 1:4441 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7826
Practice Address - Country:US
Practice Address - Phone:702-876-1000
Practice Address - Fax:702-876-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503316Medicaid
NV100503316Medicaid
NVV101989Medicare PIN