Provider Demographics
NPI:1659167534
Name:HERNANDEZ, DOMINIQUE LENORE
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:LENORE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 MEADOW PARK CIR APT 139
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-7815
Mailing Address - Country:US
Mailing Address - Phone:940-391-8543
Mailing Address - Fax:
Practice Address - Street 1:2522 MEADOW PARK CIR APT 139
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-7815
Practice Address - Country:US
Practice Address - Phone:940-391-8543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician