Provider Demographics
NPI:1598046658
Name:HERNANDEZ, JOSE MIGUEL (SLP)
Entity Type:Individual
Prefix:MR
First Name:JOSE MIGUEL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 ASPENWAY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-2822
Mailing Address - Country:US
Mailing Address - Phone:786-972-1434
Mailing Address - Fax:786-972-1434
Practice Address - Street 1:11611 ASPENWAY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2822
Practice Address - Country:US
Practice Address - Phone:832-604-3112
Practice Address - Fax:832-604-3139
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14094235Z00000X
TX113725235Z00000X
FLSZ6190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist