Provider Demographics
NPI:1730445222
Name:HERNANDEZ, PRINCESITA DIAZ (PT)
Entity type:Individual
Prefix:
First Name:PRINCESITA
Middle Name:DIAZ
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S BRYAN RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6613
Mailing Address - Country:US
Mailing Address - Phone:956-323-1570
Mailing Address - Fax:956-323-1573
Practice Address - Street 1:900 S BRYAN RD
Practice Address - Street 2:SUITE 207
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6613
Practice Address - Country:US
Practice Address - Phone:956-323-1570
Practice Address - Fax:956-323-1573
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1173893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist