=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255990909
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PASADENA OBGYN MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2019
-----------------------------------------------------
Last Update Date | 09/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4002 BURKE RD STE 300
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77504-3451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-345-1933
-----------------------------------------------------
Fax | 832-345-9722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4002 BURKE RD STE 300
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77504-3451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-897-8103
-----------------------------------------------------
Fax | 713-473-7731
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. CARLOS HERNANDEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 832-897-8103
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------