Provider Demographics
NPI:1538817341
Name:HERNANDEZ, ALEXANDRA (CCP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 DUCHESS WAY
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-1985
Mailing Address - Country:US
Mailing Address - Phone:903-366-6739
Mailing Address - Fax:
Practice Address - Street 1:3213 DUCHESS WAY
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-1985
Practice Address - Country:US
Practice Address - Phone:903-366-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF1173242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist