Provider Demographics
NPI:1235419227
Name:HERNANDEZ, RAYMOND IV (ATP)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:HERNANDEZ
Suffix:IV
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7718 LOUIS PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3402
Mailing Address - Country:US
Mailing Address - Phone:210-614-1414
Mailing Address - Fax:210-614-3078
Practice Address - Street 1:7718 LOUIS PASTEUR DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3402
Practice Address - Country:US
Practice Address - Phone:210-614-1414
Practice Address - Fax:210-614-3078
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAATP 5188332BC3200X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment