Provider Demographics
NPI:1386174274
Name:HERNANDEZ, RICARDO JR
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5960 PROVIDENCE PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-2239
Mailing Address - Country:US
Mailing Address - Phone:504-782-5110
Mailing Address - Fax:
Practice Address - Street 1:615 BARONNE ST STE 304
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-1054
Practice Address - Country:US
Practice Address - Phone:504-814-8001
Practice Address - Fax:504-617-7813
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator