Provider Demographics
NPI:1073284923
Name:HERNADEZ, RODOLFO JR
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:HERNADEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439A SAGEBRUSH CIR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3744
Mailing Address - Country:US
Mailing Address - Phone:956-236-2572
Mailing Address - Fax:
Practice Address - Street 1:439A SAGEBRUSH CIR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3744
Practice Address - Country:US
Practice Address - Phone:956-722-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant