Provider Demographics
NPI:1457087728
Name:HERNANDEZ, LUZSELENIA
Entity Type:Individual
Prefix:
First Name:LUZSELENIA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 MEMORIAL DR APT 34
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4814
Mailing Address - Country:US
Mailing Address - Phone:312-451-5197
Mailing Address - Fax:
Practice Address - Street 1:12625 MEMORIAL DR APT 34
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4814
Practice Address - Country:US
Practice Address - Phone:312-451-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010490163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse