Provider Demographics
NPI:1235889882
Name:HERNANDEZ, ARIEL
Entity Type:Individual
Prefix:
First Name:ARIEL
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 1:20302 OAKMOSS CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2569
Mailing Address - Country:US
Mailing Address - Phone:786-537-0471
Mailing Address - Fax:
Practice Address - Street 1:1311 W SAM HOUSTON PKWY N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2052
Practice Address - Country:US
Practice Address - Phone:832-612-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-26
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX843783163WC1500X
TX1089194363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health