Provider Demographics
NPI:1407440712
Name:HERNANDEZ, FABIAN JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FABIAN
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 MED CT STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3484
Mailing Address - Country:US
Mailing Address - Phone:210-494-4290
Mailing Address - Fax:210-494-4809
Practice Address - Street 1:510 MED CT STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3484
Practice Address - Country:US
Practice Address - Phone:210-494-4290
Practice Address - Fax:210-494-4809
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14438363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical