Provider Demographics
NPI:1316833023
Name:HERNANDEZ, CARLOS EDUARDO
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:EDUARDO
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 1:12760 S PARK AVE UNIT 520
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-3422
Mailing Address - Country:US
Mailing Address - Phone:801-210-1277
Mailing Address - Fax:
Practice Address - Street 1:996 W 600 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6087
Practice Address - Country:US
Practice Address - Phone:801-427-4793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator