Healthcare Provider Details

I. General information

NPI: 1356120745
Provider Name (Legal Business Name): MALLENY HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 N ED CAREY DR STE 500
HARLINGEN TX
78550-7901
US

IV. Provider business mailing address

2601 S BORDER AVE APT 6205
WESLACO TX
78596-7674
US

V. Phone/Fax

Practice location:
  • Phone: 956-622-3009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number122656
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: