MEDICARE: MRS. MARY VICTORIA HERNANDEZ P.A.

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	363A00000X	Physician Assistant	PA09002	TX

General Provider Information

NPI Number	:	1952728867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY VICTORIA HERNANDEZ P.A.

Provider Business Mailing Address
First Line	:	8610 MARTIN LUTHER KING BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-2308
Country	:	US
Telephone Number	:	713-734-0199
Fax Number	:	713-734-1564

Provider Business Practice Location Address
First Line	:	8610 MARTIN LUTHER KING BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-2308
Country	:	US
Telephone Number	:	713-734-0199
Fax Number	:	713-734-1564

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

Provider Enumeration Date	:	03/28/2014
Last Update Date	:	03/28/2014

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