Provider Demographics
NPI:1508228610
Name:HERNANDEZ-MORAN, MARTHA
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:HERNANDEZ-MORAN
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 1:605 HEMPSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7045
Mailing Address - Country:US
Mailing Address - Phone:719-289-6808
Mailing Address - Fax:
Practice Address - Street 1:2729 PORTER AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-3625
Practice Address - Country:US
Practice Address - Phone:915-566-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2092166225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant