Provider Demographics
NPI:1083439483
Name:HERNANDEZ, RUBEN A I
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:A
Last Name:HERNANDEZ
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6029 W FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5110
Mailing Address - Country:US
Mailing Address - Phone:773-543-6034
Mailing Address - Fax:
Practice Address - Street 1:6815 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-4048
Practice Address - Country:US
Practice Address - Phone:708-304-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker