Provider Demographics
NPI:1164933651
Name:HERNANDEZ, RHENSO
Entity Type:Individual
Prefix:
First Name:RHENSO
Middle Name:
Last Name:HERNANDEZ
Suffix:
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 1:5619 W LOOP 1604 N STE 124
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5796
Mailing Address - Country:US
Mailing Address - Phone:484-767-5637
Mailing Address - Fax:
Practice Address - Street 1:5619 W LOOP 1604 N STE 124
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5796
Practice Address - Country:US
Practice Address - Phone:484-767-5637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide