Provider Demographics
NPI:1659259109
Name:HERNANDEZ, RHIANNON PATRICIA
Entity type:Individual
Prefix:
First Name:RHIANNON
Middle Name:PATRICIA
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 1:7860 COFFEE ML
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78252-4514
Mailing Address - Country:US
Mailing Address - Phone:719-252-5564
Mailing Address - Fax:
Practice Address - Street 1:208 COUNTY ROAD 260 W
Practice Address - Street 2:
Practice Address - City:MICO
Practice Address - State:TX
Practice Address - Zip Code:78056-2218
Practice Address - Country:US
Practice Address - Phone:719-252-5564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB1397985106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician