Provider Demographics
NPI:1104284579
Name:HERNANDEZ, IMELDA VERONICA (CASE MANAGEMENT)
Entity type:Individual
Prefix:MS
First Name:IMELDA
Middle Name:VERONICA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CASE MANAGEMENT
Other - Prefix:MRS
Other - First Name:IMELDA
Other - Middle Name:VERONICA
Other - Last Name:TAFOLLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASE MANAGEMENT
Mailing Address - Street 1:319 W MERIDA ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-3855
Mailing Address - Country:US
Mailing Address - Phone:956-463-8360
Mailing Address - Fax:
Practice Address - Street 1:315 E JACKSON ST STE 4
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6849
Practice Address - Country:US
Practice Address - Phone:956-778-6886
Practice Address - Fax:210-618-0324
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58465171M00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator