MEDICARE: HECTOR HERNANDEZ BUCIO

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	247200000X	Other Technician	PTTC3289	TX
2	376K00000X	Nurse's Aide	NA0060034548	TX
3	247200000X	Other Technician	MA0000049870	TX

General Provider Information

NPI Number	:	1922875574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR HERNANDEZ BUCIO

Provider Business Mailing Address
First Line	:	5923 GRANDWOOD DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78239-1507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5923 GRANDWOOD DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78239-1507
Country	:	US
Telephone Number	:	210-462-3468
Fax Number	:

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

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	12/05/2023

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