Provider Demographics
NPI:1326127507
Name:HERNANDEZ, CARLOS ANTONIO SR (MD)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ANTONIO
Last Name:HERNANDEZ
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 SPENCER HWY
Mailing Address - Street 2:#C
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1224
Mailing Address - Country:US
Mailing Address - Phone:713-473-7681
Mailing Address - Fax:713-473-7731
Practice Address - Street 1:4001 SPENCER HWY
Practice Address - Street 2:#C
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1224
Practice Address - Country:US
Practice Address - Phone:713-473-7681
Practice Address - Fax:713-473-7731
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5224207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115382702Medicaid
TX115382702Medicaid
L43JMedicare ID - Type Unspecified