Provider Demographics
NPI:1861828048
Name:HERNANDEZ, ALYSSA (LAB)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LAB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NEWCOMBE AVE
Mailing Address - Street 2:
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447-2212
Mailing Address - Country:US
Mailing Address - Phone:775-294-5242
Mailing Address - Fax:
Practice Address - Street 1:2 NEWCOMBE AVE
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-2212
Practice Address - Country:US
Practice Address - Phone:775-294-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV28205AL-3291U00000X
NV28205AL-1291U00000X
NV28205-AL-4246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No291U00000XLaboratoriesClinical Medical Laboratory