Provider Demographics
NPI:1285229153
Name:HERNANDEZ, SERGIO JESUS (ATC)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:JESUS
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 SEVEN IRON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3158
Mailing Address - Country:US
Mailing Address - Phone:210-852-1293
Mailing Address - Fax:
Practice Address - Street 1:1102 SEVEN IRON WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-3158
Practice Address - Country:US
Practice Address - Phone:210-852-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20000537252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer