Healthcare Provider Details

I. General information

NPI: 1013579648
Provider Name (Legal Business Name): MARTIN VICENTE HERNANDEZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N 16TH ST STE 115
MCALLEN TX
78501-7983
US

IV. Provider business mailing address

214 N 16TH ST STE 115
MCALLEN TX
78501-7983
US

V. Phone/Fax

Practice location:
  • Phone: 956-605-9970
  • Fax: 972-920-9350
Mailing address:
  • Phone: 956-605-9970
  • Fax: 972-920-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number795070
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number795070
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number795070
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: