Provider Demographics
NPI:1902431976
Name:HERNANDEZ, THOMAS JR
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
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 1:7304 ROBERT MICHAELS ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-4223
Mailing Address - Country:US
Mailing Address - Phone:956-257-3204
Mailing Address - Fax:
Practice Address - Street 1:7304 ROBERT MICHAELS ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-4223
Practice Address - Country:US
Practice Address - Phone:956-257-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications