Basic Information
| Provider Information | |||||||||
| NPI: | 1427301159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | FEDERICO | ||||||||
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| Credential: | LCDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 GUANAJUATO | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782374238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8308793047 | ||||||||
| FaxNumber: | 8308792940 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 W HONDO AVE BLDG 100 | ||||||||
| Address2: | |||||||||
| City: | DEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780161921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306639786 | ||||||||
| FaxNumber: | 8306639800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2012 | ||||||||
| LastUpdateDate: | 10/18/2012 | ||||||||
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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 | 101YA0400X | 1182 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.