Provider Demographics
NPI:1558908962
Name:HERNANDEZ, CRYSTAL
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
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 1:2928 FALLCREST BND
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-4339
Mailing Address - Country:US
Mailing Address - Phone:512-582-7048
Mailing Address - Fax:512-582-7048
Practice Address - Street 1:2020 N BELL BLVD STE B3-E
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6526
Practice Address - Country:US
Practice Address - Phone:512-582-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1002175332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies