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General NPI Number Information
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NPI Number | 1497201164
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Entity Type | Individual
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Provider Name | MAYRENA ISAMAR HERNANDEZ PHD, MPH, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 7201 LAKE JACKSON DR
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City | ARLINGTON
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State | TX
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Zip | 76002-4070
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Country | US
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Telephone | 817-600-7749
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Fax |
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Provider Business Mailing Address
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Address Line | 3321 ROLLING VIEW CT
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City | CONROE
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State | TX
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Zip | 77301-2093
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Country | US
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Telephone | 817-600-7749
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | AT6669
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License Number State | TX
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