Basic Information
| Provider Information | |||||||||
| NPI: | 1255541298 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUGO R. HERNANDEZ, M.D., P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 343 W HOUSTON ST | ||||||||
| Address2: | STE 807 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782052107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102291900 | ||||||||
| FaxNumber: | 2102299890 | ||||||||
| Practice Location | |||||||||
| Address1: | 343 W HOUSTON ST | ||||||||
| Address2: | STE 807 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782052107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102291900 | ||||||||
| FaxNumber: | 2102299890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 04/07/2010 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | HUGO | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2102291900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | G0428 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 099734801 | 05 | TX | MEDICAID | 00PN21 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |