Healthcare Provider Details

I. General information

NPI: 1740959733
Provider Name (Legal Business Name): MR. HUMBERTO HINOJOSA III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W OCEAN BLVD
LOS FRESNOS TX
78566-3635
US

IV. Provider business mailing address

PO BOX 239
BENAVIDES TX
78341-0239
US

V. Phone/Fax

Practice location:
  • Phone: 956-233-4111
  • Fax:
Mailing address:
  • Phone: 361-207-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number40790
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: