Provider Demographics
NPI:1336854769
Name:HERNANDEZ, JOEL ARRON
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ARRON
Last Name:HERNANDEZ
Suffix:
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 1:1948 NE CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6697
Mailing Address - Country:US
Mailing Address - Phone:805-766-1881
Mailing Address - Fax:
Practice Address - Street 1:1948 NE CLIFF DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6697
Practice Address - Country:US
Practice Address - Phone:805-766-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA745442163W00000X
AZRN180514163W00000X
OR201504977RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse