Healthcare Provider Details

I. General information

NPI: 1821014051
Provider Name (Legal Business Name): JANICE ELAINE BRUNSTROM-HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7709 SAN JACINTO PL STE 203
PLANO TX
75024-3368
US

IV. Provider business mailing address

PO BOX 251665
PLANO TX
75025-1515
US

V. Phone/Fax

Practice location:
  • Phone: 469-331-0030
  • Fax: 469-331-0031
Mailing address:
  • Phone: 469-331-0030
  • Fax: 469-331-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number101182
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberM5074
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: