Provider Demographics
NPI:1225617558
Name:HERNANDEZ, JUAN ALONSO (PA)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ALONSO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 BOCA CHICA BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3496
Mailing Address - Country:US
Mailing Address - Phone:956-546-2000
Mailing Address - Fax:956-546-2001
Practice Address - Street 1:2534 BOCA CHICA BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3496
Practice Address - Country:US
Practice Address - Phone:956-546-2000
Practice Address - Fax:956-546-2001
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant