Provider Demographics
NPI:1508903337
Name:HERNANDEZ, IZAIC JOHN (ARLOPP,TXLPOA)
Entity Type:Individual
Prefix:
First Name:IZAIC
Middle Name:JOHN
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:ARLOPP,TXLPOA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16543 CRESTED BUTTE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1503
Mailing Address - Country:US
Mailing Address - Phone:210-264-9037
Mailing Address - Fax:
Practice Address - Street 1:540 MADISON OAK DR STE 270
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3930
Practice Address - Country:US
Practice Address - Phone:210-495-3399
Practice Address - Fax:210-495-3393
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR00083222Z00000X, 224P00000X
TX334225000000X
000751744P3200X
0056174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No174400000XOther Service ProvidersSpecialist