Healthcare Provider Details

I. General information

NPI: 1538168661
Provider Name (Legal Business Name): JAIME N HERNANDEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 BUSINESS IH 35 EAST
PEARSALL TX
78061-2804
US

IV. Provider business mailing address

1739 BUSINESS IH 35 EAST
PEARSALL TX
78061-2804
US

V. Phone/Fax

Practice location:
  • Phone: 830-334-8748
  • Fax: 830-334-3135
Mailing address:
  • Phone: 830-334-8748
  • Fax: 830-334-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JAIME NAVA HERNANDEZ
Title or Position: OWNER
Credential:
Phone: 830-334-8748