MEDICARE: DR. MAYRENA ISAMAR HERNANDEZ PHD, MPH, ATC, LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	AT6669	TX

General Provider Information

NPI Number	:	1497201164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAYRENA ISAMAR HERNANDEZ PHD, MPH, ATC, LAT

Provider Business Mailing Address
First Line	:	3321 ROLLING VIEW CT
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-2093
Country	:	US
Telephone Number	:	817-600-7749
Fax Number	:

Provider Business Practice Location Address
First Line	:	7201 LAKE JACKSON DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4070
Country	:	US
Telephone Number	:	817-600-7749
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	01/30/2023

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