Provider Demographics
NPI:1861713158
Name:HERNANDEZ, YOLANDA R (MS)
Entity type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:R
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 DOUG OLSON DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5605
Mailing Address - Country:US
Mailing Address - Phone:915-598-6816
Mailing Address - Fax:915-594-2730
Practice Address - Street 1:11220 ROJAS DR
Practice Address - Street 2:SUITE A-6
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-5400
Practice Address - Country:US
Practice Address - Phone:915-598-6816
Practice Address - Fax:915-594-2730
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089287902Medicaid
TX456746Medicare PIN