Provider Demographics
NPI:1073263117
Name:HERNANDEZ CENTENO, FERNANDO
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:HERNANDEZ CENTENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FERNANDO
Other - Middle Name:
Other - Last Name:CENTENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 BAYLOR PLZ # BCM320
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3498
Mailing Address - Country:US
Mailing Address - Phone:832-824-1170
Mailing Address - Fax:832-825-6497
Practice Address - Street 1:1 BAYLOR PLZ # BCM320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3498
Practice Address - Country:US
Practice Address - Phone:832-824-1170
Practice Address - Fax:832-825-6497
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program