Healthcare Provider Details

I. General information

NPI: 1700185147
Provider Name (Legal Business Name): FERNANDEZ GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 W US HIGHWAY 77 STE C
SAN BENITO TX
78586-4180
US

IV. Provider business mailing address

1595 W US HIGHWAY 77 STE C
SAN BENITO TX
78586-4180
US

V. Phone/Fax

Practice location:
  • Phone: 956-399-4500
  • Fax: 956-399-4505
Mailing address:
  • Phone: 956-399-4500
  • Fax: 956-399-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HENRY FERNANDEZ
Title or Position: OWNER
Credential:
Phone: 956-399-4500