Healthcare Provider Details

I. General information

NPI: 1730493024
Provider Name (Legal Business Name): ANN MARIE HERNANDEZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21031 MARKET RDG
SAN ANTONIO TX
78258-2483
US

IV. Provider business mailing address

21031 MARKET RDG
SAN ANTONIO TX
78258-2483
US

V. Phone/Fax

Practice location:
  • Phone: 210-233-6148
  • Fax: 210-399-8721
Mailing address:
  • Phone: 210-233-6148
  • Fax: 210-399-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35185
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: