Provider Demographics
NPI:1063805935
Name:HERNANDEZ, MANUEL (PA)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4820
Mailing Address - Country:US
Mailing Address - Phone:830-773-3331
Mailing Address - Fax:830-773-2981
Practice Address - Street 1:290 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4820
Practice Address - Country:US
Practice Address - Phone:830-773-3331
Practice Address - Fax:830-773-2981
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant