Provider Demographics
NPI:1033675384
Name:HERNANDEZ, JOSSELYN
Entity Type:Individual
Prefix:
First Name:JOSSELYN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 RIVER RD APT 14206
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-2674
Mailing Address - Country:US
Mailing Address - Phone:346-240-0134
Mailing Address - Fax:
Practice Address - Street 1:650 RIVER RD APT 14206
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-2674
Practice Address - Country:US
Practice Address - Phone:346-240-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program