Basic Information
| Provider Information | |||||||||
| NPI: | 1386183663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | LUIS | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7931 BURNING OAK LN | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774073370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818395969 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7600 FANNIN ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770541906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137901234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2017 | ||||||||
| LastUpdateDate: | 07/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 770163 | TX | N | Nursing Service Providers | Registered Nurse | 367500000X | AP134285 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.