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NPI Code Detail

MEDICARE: JUANITA HERNANDEZ

MEDICARE: JUANITA HERNANDEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker04117TX

General Provider Information

NPI Number : 1699098012
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUANITA HERNANDEZ
Provider Business Mailing Address
First Line : 6969 PASTOR BAILEY DR
Second Line : SUITE 140
City : DALLAS
State : TX
Zip : 75237-2636
Country : US
Telephone Number : 972-298-3366
Fax Number : 214-920-8494
Provider Business Practice Location Address
First Line : 6969 PASTOR BAILEY DR
Second Line : SUITE 140
City : DALLAS
State : TX
Zip : 75237-2636
Country : US
Telephone Number : 972-298-3366
Fax Number : 214-920-8494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2010
Last Update Date : 03/12/2010

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Directions to “ JUANITA HERNANDEZ ” Practice Location

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