Provider Demographics
NPI:1730794074
Name:HERNANDEZ, OSCAR RENE (LMT)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:RENE
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:OSCAR
Other - Middle Name:RENE
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 920441
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-0009
Mailing Address - Country:US
Mailing Address - Phone:915-790-8362
Mailing Address - Fax:
Practice Address - Street 1:6006 N MESA ST STE 220
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4618
Practice Address - Country:US
Practice Address - Phone:915-790-8362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT116417225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist