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General NPI Number Information
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NPI Number | 1184800898
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Entity Type | Individual
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Provider Name | LUIS HERNANDEZ LSA
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Gender | Male
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 21175 TOMBALL PARKWAY PMB # 122
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City | HOUSTON
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State | TX
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Zip | 77070-1655
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Country | US
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Telephone | 281-256-5702
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Fax |
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Provider Business Mailing Address
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Address Line | 21175 TOMBALL PKWY PMB # 122
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City | HOUSTON
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State | TX
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Zip | 77070-1655
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Country | US
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Telephone | 281-256-5702
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | SA00334
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License Number State | TX
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