Provider Demographics
NPI:1538168661
Name:JAIME N HERNANDEZ
Entity type:Organization
Organization Name:JAIME N HERNANDEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:NAVA
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-334-8748
Mailing Address - Street 1:1739 BUSINESS IH 35 EAST
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061-2804
Mailing Address - Country:US
Mailing Address - Phone:830-334-8748
Mailing Address - Fax:830-334-3135
Practice Address - Street 1:1739 BUSINESS IH 35 EAST
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-2804
Practice Address - Country:US
Practice Address - Phone:830-334-8748
Practice Address - Fax:830-334-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649212-02Medicaid
TX191179401Medicaid
TX191179402Medicaid
TX1649212-01Medicaid
TX1649212-02Medicaid
TX1649212-01Medicaid