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General NPI Number Information
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NPI Number | 1447963350
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Entity Type | Individual
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Provider Name | JOSE DAMIAN HERNANDEZ
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Gender | Male
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 8575 PITNER RD
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City | HOUSTON
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State | TX
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Zip | 77080-2010
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Country | US
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Telephone | 713-462-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 5502 1ST ST
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City | KATY
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State | TX
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Zip | 77493-2472
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Country | US
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Telephone | 713-462-6565
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 69609
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License Number State | TX
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