Provider Demographics
NPI:1154413813
Name:HERNANDEZ, RAFAELA GUTIERREZ (MD)
Entity type:Individual
Prefix:
First Name:RAFAELA
Middle Name:GUTIERREZ
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W 6TH ST
Mailing Address - Street 2:#301
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4590
Mailing Address - Country:US
Mailing Address - Phone:775-348-2983
Mailing Address - Fax:775-348-2975
Practice Address - Street 1:236 W 6TH ST
Practice Address - Street 2:#301
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4590
Practice Address - Country:US
Practice Address - Phone:775-348-2983
Practice Address - Fax:775-348-2975
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10759207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV1025OtherANTHEM B/C B/S
I05147Medicare UPIN
39178Medicare ID - Type Unspecified