Provider Demographics
NPI:1497201164
Name:HERNANDEZ, MAYRENA ISAMAR (PHD, MPH, ATC, LAT)
Entity Type:Individual
Prefix:DR
First Name:MAYRENA
Middle Name:ISAMAR
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHD, MPH, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 ROLLING VIEW CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2093
Mailing Address - Country:US
Mailing Address - Phone:817-600-7749
Mailing Address - Fax:
Practice Address - Street 1:7201 LAKE JACKSON DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4070
Practice Address - Country:US
Practice Address - Phone:817-600-7749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT6669174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist