Provider Demographics
NPI:1003887795
Name:HERNANDEZ, GUILLERMO E (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:E
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8511 MCPHERSON ROAD
Mailing Address - Street 2:SUITE 105, PMB 233
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045
Mailing Address - Country:US
Mailing Address - Phone:956-523-2619
Mailing Address - Fax:
Practice Address - Street 1:10700 MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6268
Practice Address - Country:US
Practice Address - Phone:956-523-2619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX507056367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138646818Medicaid
TX84155UOtherBCBS
TX138646816Medicaid
TXP00184690OtherMEDICARE RAILROAD
TX84155UOtherBCBS
TX138646816Medicaid