Provider Demographics
NPI:1033486428
Name:HERNANDEZ, GERARDO (CSFA)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 W BRAKER LN # 81603
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-3606
Mailing Address - Country:US
Mailing Address - Phone:512-973-9222
Mailing Address - Fax:512-777-4527
Practice Address - Street 1:1822 W BRAKER LN # 81603
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-3606
Practice Address - Country:US
Practice Address - Phone:512-973-9222
Practice Address - Fax:512-777-4527
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129072246ZC0007X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant