Provider Demographics
NPI:1568804086
Name:HERNANDEZ, MARISELA BEATRIZ (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISELA
Middle Name:BEATRIZ
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 S CYNTHIA ST STE 106
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1387
Mailing Address - Country:US
Mailing Address - Phone:956-687-3318
Mailing Address - Fax:956-687-4878
Practice Address - Street 1:2010 S CYNTHIA ST STE 106
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1387
Practice Address - Country:US
Practice Address - Phone:956-687-3318
Practice Address - Fax:956-687-4878
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05198363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical