Healthcare Provider Details

I. General information

NPI: 1841892742
Provider Name (Legal Business Name): SAMUEL HERNANDEZ JR. CST/CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2020
Last Update Date: 03/20/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 WILDER LN
CORPUS CHRISTI TX
78414
US

IV. Provider business mailing address

PO BOX 8145
CORPUS CHRISTI TX
78468-8145
US

V. Phone/Fax

Practice location:
  • Phone: 361-537-2422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00844
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: